Hospital cost of knee arthroplasty in the Brazilian Unified Health System (SUS) in Goiás

an analysis of DATASUS data

Abstract

Introduction: Knee arthroplasty represents a significant portion of orthopedic surgical procedures within the Unified Health System (SUS), generating substantial hospital costs. However, regional disparities in resource allocation and expenditure patterns remain underexplored, particularly in the state of Goiás. Objetives: Analyze the hospital cost, temporal trends, and geographic distribution of knee arthroplasties funded by the SUS in the state, using public data from the Department of Informatics of the SUS (DATASUS) Methods: A retrospective analysis was conducted using public data from the DATASUS database. Hospital Admission Authorizations (AIH) for knee arthroplasties performed between January 2008 and July 2025 in Goiás were collected. Descriptive statistics were applied to assess temporal trends, geographic distribution, and mean cost per procedure. A statistical test for trend analysis was performed for the 2008–2024 period. Results: The analysis of DATASUS data revealed a total of 2,521 approved Hospital Admission Authorizations (AIH), corresponding to a total expenditure of R$ 11,949,392.25. The data include four types of procedures: non-conventional knee arthroplasty, revision/ reconstruction total knee arthroplasty, primary total knee arthroplasty, and primary unicompartmental knee arthroplasty. The annual average was 148.3 procedures, with significant variability over the years. The lowest number of procedures was recorded in 2008 (37 AIH), and the highest in 2019 (330 AIH). An overall upward trend was observed until 2019, followed by a decline in 2020–2021, possibly related to the COVID-19 pandemic, and subsequent recovery in 2022–2024. The geographic distribution of knee arthroplasty procedures and expenditures in Goiás shows an extreme concentration in the capital and metropolitan region. Procedures were performed in only six municipalities throughout the study period, highlighting a severe centralization of high-complexity services in the state. Goiânia accounted for 85.0% of all AIH (2,144 procedures) and 81.2% of all expenditures (R$ 9,700,469.96), followed by Anápolis with 6.1% of AIH (155 procedures) and 8.9% of expenditures (R$ 1,069,067.04). The metropolitan region of Goiânia, including Aparecida de Goiânia, accounted for 87.5% of all procedures performed in the state. Conclusion: The analysis of hospital costs of knee arthroplasties in the SUS in Goiás reveals a scenario of extreme geographic concentration, with only six municipalities performing procedures across the entire state during the period from 2008 to 2024. Goiânia concentrated 85.0% of the procedures and 81.2% of the expenditures, highlighting a centralization that significantly compromises equitable access to treatment for the population living in non-metropolitan areas. The mean cost per procedure (R$ 4,739.94) was slightly higher than the national average, with important variability between municipalities, warranting further investigation into its deter mining factors.