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Previous issue date: 2014-12-08 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / The objective of this dissertation was to analyze some aspects related to the Roux-en-Y gastric bypass (RYGB) surgery access routes such as health effects, costs and possible diffusion of laparoscopy to the Brazilian National Public Health System (BNPHS). So, two papers were presented, aiming the comparison of the economic evaluation of both surgical routes (laparoscopy and laparotomy) and the evaluation of a possible diffusion rate of laparoscopy in the BNPHS. Article 1 was entitled "Systematic Review of the Economic Evaluation of Laparotomy versus Laparoscopy for Patients Who Underwent Roux-en-Y gastric bypass (RYGB) surgery" and aimed to analyze the cost-effectiveness of laparoscopic and laparotomic routes. The electronic databases used were MEDLINE, Embase, Scopus, Cochrane and Lilacs. From the 494 articles found, 6 met the inclusion criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies met less than half of the items that assessed the quality of results; two met five of the necessary items, and only one study met seven of 10 items. Five studies considered laparoscopic surgery the dominant strategy, because they presented higher clinical benefits (less likelihood of postoperative complications, shorter hospitalization) and lower total cost. This evaluation indicates that laparoscopy is a safe and well tolerated technique, although surgery costs are higher compared to laparotomy. However, the additional costs are offset by lower probability of complications after surgery. Article 2 was entitled "Implementing Laparoscopy in Brazil?s National Public Health System (BNPHS) ? the Bariatric Surgeons? point of view? and aimed to estimate 1) whether bariatric surgeons would support eventual incorporation of laparoscopy to the BNPHS; 2) whether there would be an increase in the total number of operations in case of availability of this option of access route; and 3) how would the redistribution of these two operation routes be. Using the Delphi method, we enlisted a panel of bariatric surgeons who answered a questionnaire previously developed for this purpose. In order to get a better consensus, two rounds were held. Of the 45 surgeons who attended a national event, 30 (66.7%) answered the Delphi questionnaire, which corresponded to the first round of the study. In the second, the final, round, 22 (48.9%) out of the 30 surgeons answered the questionnaire. Considering the possibility of incorporating the laparoscopic route in the BNPHS, approximately 95% of surgeons have expressed interest in choosing it. If the operation by laparoscopy was incorporated into the BNPHS, there would be a total average increase of 25% in the number of surgeries performed. So, in this new configuration system, the distribution of surgical procedures would be as follow: 62.5% and 37.5% by laparoscopy and laparotomy respectively. In conclusion 1) there was preference for laparoscopic route; 2) there would be an increase in the number of surgeries performed; and 3) the distribution of surgical procedures would be 62.5% by laparoscopy and 37.5% by laparotomy. / O objetivo dessa tese foi analisar os aspectos relacionados ?s vias de acesso da cirurgia bari?trica Bypass Gastrointestinal em Y de Roux (RYGB) referentes a efeitos em sa?de, custos e eventual taxa de difus?o da laparoscopia no Sistema ?nico de Sa?de (SUS). Para tanto, dois artigos s?o apresentados, visando ? avalia??o econ?mica das vias de acesso por laparoscopia e laparotomia, e a estimativa de eventual taxa de difus?o da laparoscopia no SUS. O artigo 1 intitulou-se ? Revis?o Sistem?tica de Avalia??o Econ?mica da Laparotomia versus Laparoscopia para Pacientes Submetidos ao Bypass Gastrointestinal em Y de Roux (RYGB)? e teve como objetivo analisar o custo-efetividade da cirurgia por acesso laparosc?pico e laparot?mico. Foram utilizadas as bases de dados eletr?nicas MEDLINE, Embase, Scopus, Cochrane e Lilacs. De 494 artigos, 6 preencheram os crit?rios de inclus?o. Todos os estudos foram publicados entre 2001 e 2008 nos Estados Unidos (EUA). Tr?s estudos preencheram menos de metade dos ?tens que avaliaram a qualidade dos resultados; dois preencheram 5 dos ?tens necess?rios, e apenas um estudo preencheu sete dos 10 ?tens. Cinco estudos consideraram a cirurgia por laparoscopia a estrat?gia dominante, pois apresentaram maiores benef?cios cl?nicos (menos probabilidade de complica??es p?s-cir?rgicas, menor tempo de interna??o) e menor custo total. Esta avalia??o indica que a laparoscopia ? uma t?cnica segura e bem tolerada, apesar de os custos da cirurgia serem maiores quando comparados com a laparotomia. No entanto, os custos adicionais s?o compensados pela menor probabilidade de complica??es ap?s a cirurgia e, conseq?entemente, evitando os seus custos. No artigo 2 intitulou-se ?Ades?o dos Cirurgi?es Bari?tricos ? Laparoscopia no Sistema ?nico de Sa?de do Brasil? e teve como objetivos estimar se os cirurgi?es bari?tricos apoiariam eventual incorpora??o da opera??o por via laparosc?pica no SUS; se haveria incremento no n?mero total de opera??es caso houvesse esta nova op??o de via de acesso; e como seria a redistribui??o da oferta de opera??es pelas duas vias. Com o m?todo Delphi, foi constru?do um painel de especialistas, em que cirurgi?es bari?tricos responderam um question?rio previamente desenvolvido para esse fim. Foram realizadas duas rodadas, no intuito de melhor consenso. Dos 45 cirurgi?es que estiveram presentes no evento nacional, 30 (66,7%) participaram do question?rio Delphi, o que correspondeu ? primeira rodada do estudo. Na segunda, e ?ltima rodada, dos 30 respondentes da primeira etapa, 22 (48,9%) cirurgi?es responderam. Mediante a possibilidade de incorpora??o da via laparosc?pica no SUS, aproximadamente 95% dos cirurgi?es manifestaram interesse em realiz?-la. Caso a opera??o por laparoscopia fosse incorporada no SUS, haveria incremento m?dio no n?mero de opera??es na ordem de 25%; nesta nova configura??o, a oferta de procedimentos cir?rgicos estaria distribu?da da seguinte forma: 62,5% por laparoscopia e 37,5% por laparotomia. Concluiu-se que: 1) Houve prefer?ncia pela via laparosc?pica; 2) haveria incremento no n?mero de opera??es comparado ao modelo atual em que apenas a via laparot?mica est? dispon?vel aos usu?rios do sistema p?blico; e 3) a distribui??o em rela??o ao tipo de procedimento seria de 62,5% por laparoscopia e 37,5% por laparotomia.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/5942 |
| Date | 08 December 2014 |
| Creators | S?ssenbach, Samanta Pereira |
| Contributors | Mottin, Cl?udio Cor?, Silva, Everton N. |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 600, 600, 600, 600, -8624664729441623247, -969369452308786627, -2555911436985713659 |
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