ASSISTENTIAL CENTRALIZATION OF APPENDECTOMIES IN SÃO PAULO STATE: FLOW ANALYSIS AND TRENDS ACROSS MUNICIPALITIES (2012–2024)

Authors

  • Thiago da Silva Cornelio
  • Daniela Fernandes Notaro
  • Érica Caroline de Almeida
  • Rúbia Betin Queirós
  • Alfredo Mendes Nogueira Neto
  • Mariza Ribeiro Lisboa Hostt
  • Rebeca Blézins Arruda Teixeira
  • Nicolas Kipman Cerqueira
  • Wilson Rodrigues de Freitas Junior

DOI:

https://doi.org/10.63330/sasciencesv6n2-030

Keywords:

Appendectomy, Laparoscopy, Appendicitis, Health regionalization, Unified Health System

Abstract

Appendectomies are among the most frequently performed emergency surgical procedures within the Brazilian Unified Health System (SUS), and their organization reflects relevant structural inequalities. This ecological time-series study describes the spatial distribution, patient flows, and temporal trends of appendectomies performed by the SUS in the state of São Paulo between 2012 and 2024, emphasizing concentration by hospitalization municipality, laparoscopic adoption, and in-hospital outcomes, using secondary data from the Hospital Information System (SIH/DATASUS), including inpatient stays with open and laparoscopic appendectomy procedures and ICD-10 diagnoses K35–K37. Concentration was quantified using the Herfindahl-Hirschman Index (HHI), trends were assessed by linear regression, and ecological associations by Pearson correlation. A total of 305,606 appendectomies were identified, with a reduction of 269.8 cases per year (p = 0.007); laparoscopy grew from 1.7% (2012) to 21.2% (2024), with an increase of 1.43 percentage points per year (R² = 0.843; p < 0.001). In-hospital mortality was 0.29%, with no significant trend, and length of stay decreased from 3.5 to 3.1 days, while the mean cost rose from BRL 601 to BRL 780. Concentration was high: 5.9% of municipalities accounted for 50% of cases, and 78.1% lacked a local surgical inpatient service. It is concluded that the state of São Paulo presents high centralization of SUS appendectomies, with progressive but heterogeneous laparoscopy adoption and persistent inter-regional flows, providing evidence for the regional planning of emergency surgical networks.

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Published

2026-06-23

How to Cite

Cornelio, T. da S. ., Notaro, D. F. ., de Almeida, Érica C. ., Queirós, R. B. ., Nogueira Neto, A. M. ., Hostt, . M. R. L. ., Teixeira, R. B. A. ., Cerqueira, N. K. ., & de Freitas Junior, W. R. . (2026). ASSISTENTIAL CENTRALIZATION OF APPENDECTOMIES IN SÃO PAULO STATE: FLOW ANALYSIS AND TRENDS ACROSS MUNICIPALITIES (2012–2024). South American Sciences, 6(2), 1–18. https://doi.org/10.63330/sasciencesv6n2-030

Issue

Vol. 6 No. 2 (2026): South American Sciences

Section

Artigos

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