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

Gonçalves Filho, Geraldo Mota; de Souza, Danilo Arruda; Engel, Edgard Eduard

doi:10.1590/1413-785220253306e293805

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Original Article/Orthopedic Oncology • Acta Ortop Bras 33 (6) • 2025 • https://doi.org/10.1590/1413-785220253306e293805 linkcopy

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

ONDE ESTÃO OS CENTROS DE ONCOLOGIA ORTOPÉDICA NO SUS?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords:
Health Services Accessibility; Cancer Care Facilities; Bone Neoplasms; Orthopedics

State	Population	%	Centers	%	Procedures	%	OOC/M. inhab.	Procedures/M. inhab.
SP	45,919,049	21.9	17	29.3	2207	24.9	0.37	48
MG	21,168,791	10.1	6	10.3	812	9.2	0.28	38
RJ	17,264,943	8.2	1	1.7	169	1.9	0.06	10
BA	14,873,064	7.1	2	3.4	1055	11.9	0.13	71
PR	11,433,957	5.4	6	10.3	811	9.2	0.52	71
RS	11,377,239	5.4	4	6.9	479	5.4	0.35	42
PE	9,557,071	4.5	4	6.9	1039	11.7	0.42	109
CE	9,132,078	4.3	3	5.2	779	8.8	0.33	85
PA	8,602,865	4.1	2	3.4	138	1.6	0.23	16
SC	7,164,788	3.4	4	6.9	122	1.4	0.56	17
GO	7,018,354	3.3	1	1.7	333	3.8	0.14	47
AM	4,144,597	2.0	1	1.7	141	1.6	0.24	34
ES	4,018,650	1.9	1	1.7	57	0.6	0.25	14
PB	4,018,127	1.9	1	1.7	246	2.8	0.25	61
RN	3,506,853	1.7	1	1.7	159	1.8	0.29	45
PI	3,273,227	1.6	1	1.7	172	1.9	0.31	53
DF	3,015,268	1.4	2	3.4	128	1.4	0.66	42
SE	2,298,696	1.1	1	1.7	14	0.2	0.44	6
BRAZIL	210.147.125	100	58	100.0	8861	100.0	0.28	42
SD							0.15	27

Region	Population	%	Centers	%	Procedures	%	OOC/M. de inhab.	Procedures/M. de inhab.
Southeast	88,371,433	42.1	25	43.1	3,245	36.6	0.28	37
Northeast	57,071,654	27.2	13	22.4	3,464	39.1	0.23	61
South	29,975,984	14.3	14	24.1	1,412	15.9	0.47	47
North	18,430,980	8.8	2	3.4	279	3.1	0.11	15
Center-West	16,297,074	7.8	4	6.9	461	5.2	0.25	28
Brazil	210,147,125	100	58		8,861		0.28	42
SD							0.12	16

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[TFN1] OOC: Orthopedic Oncology Center according to this study's criteria. M. inhab.: million inhabitants. SD: standard deviation. States without OOC: Acre; Alagoas; Amapá; Maranhão; Mato Grosso; Mato Grosso do Sul; Rondônia; Roraima; Tocantins.