# WHERE ARE THE ORTHOPEDIC ONCOLOGY CENTERS IN THE BRAZILIAN UNIFIED HEALTH SYSTEM (SUS)?

## TL;DR

This study maps and analyzes the distribution of orthopedic oncology centers in Brazil's public health system, finding a concentration of procedures in a few high-volume centers.

## Contribution

The paper provides the first comprehensive analysis of orthopedic oncology center distribution and surgical volume within Brazil's SUS.

## Key findings

- 58 orthopedic oncology centers were identified across 18 Brazilian states.
- High-volume centers performed 95% of the surgeries, while low-volume centers performed only 5%.
- The Northeast region had the highest concentration of procedures, while the South had the highest number of centers per population.

## Abstract

To identify and analyze the geographical distribution, surgical volume, and population adequacy of Orthopedic Oncology Centers (OOCs) within the Brazilian Unified Health System (SUS).

We evaluated 11,139 procedures recorded in Hospitalization Authorizations (AIHs) between 2008 and 2019, including "hemipelvectomy in oncology" and "resection of bone tumors with replacement or reconstruction." Hospitals performing both procedures and at least three hemipelvectomies during this period were classified as OOCs.

A total of 58 OOCs were identified in 18 states, accounting for 79.5% of all procedures. Most patients (93.7%) were treated in their home state. High-Volume Centers (HVCs) performed 95% of the surgeries, while Low-Volume Centers (LVCs) were responsible for only 5%. The Northeast region concentrated 39.1% of procedures, while the South had the highest number of OOCs per population.

The geographical distribution of OOCs in Brazil is relatively adequate; however, procedures are highly concentrated in a few high-volume centers. This centralization may be associated with better clinical outcomes, reinforcing the need for policies that encourage specialized treatment in reference units.
Level of Evidence III; Cross-Sectional Observational Study
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