Temporal trends of cholecystectomy in the Brazilian SUS

hospital payments and mortality, 2014–2025

Abstract

Objective: To analyze hospitalizations, in-hospital mortality, length of stay, and SUS hospital payment indicators related to cholecystectomy in the Brazilian Unified Health System (SUS), 2014–2025. Methods: Ecological, retrospective, descriptive, and analytical study using SIH/SUS data retrieved through the microdatasus package. Rates per 100,000 inhabitants were calculated, SUS payments were adjusted by the IPCA (base year December 2024), and temporal trends assessed by Prais-Winsten regression (2014–2024). Data from 2025 were included only for descriptive purposes, as they may be incomplete due to SIH/SUS processing lag. Results: A total of 2,754,596 hospitalizations and 58,541 in-hospital deaths were recorded, with total SUS payments of R$ 2.97 billion in real values. The hospitalization rate ranged from 64.42 (2020) to 146.84 (2024) per 100,000 inhabitants. In 2020, a 42.5% reduction in hospitalizations was observed, coinciding with the COVID-19 pandemic. In-hospital mortality showed a descriptive decline from 2.26% (2014) to 1.71% (2024). Mean real payment per admission was the only indicator with a statistically significant decreasing trend (β = −R$ 26.77/year; p = 0.041); hospitalization rates, in-hospital mortality, and length of stay were stationary. Conclusions: Cholecystectomy in the SUS showed a descriptive increase in procedure volume, a descriptive decline in in-hospital mortality, and a statistically significant decreasing trend in mean real payment per admission, with disruption coinciding with the COVID-19 pandemic and persistent regional inequalities.