Presented by: Oscar Fugita MD, PhD
Hospital Universitario - Universidade de Sao Paulo

Introduction

The Brazilian Public Health System (SUS) is the largest and one of the most complex public health systems in the world. It allows any person living in Brazil to have universal access to the Brazilian public health system, guaranteeing health support to more than 170 million people. The Brazilian Public Health Information System (DATASUS) is a publicly available database that comprises information from SUS including those from all public health hospitals throughout the country.

Some previous papers evaluated the impact of the COVID-19 outbreak on acute urinary stone presentation, hospitalizations and management. However, to the best of our knowledge, no previous publication addressed the impact of the COVID-19 pandemia on the access of patients with urinary stones to the health system. The aim of this paper is to present the impact of the COVID-19 outbreak on consultations and radiological exams for urinary stones in the SUS.

Materials

This is a cross-sectional study reviewing health system access (urgent and elective consultation) and access to radiological exams (CT-scans and Ultrasounds) from de DATASUS. All gathered information associated with the urolithiasis diagnosis (ICD-10 N20) between January 2018 and December 2022 was analysed. Urgent and elective consultations and radiological (CT-scans and US) exams were differentiated in the statistics. There was no need for IRB or informed consent as DATASUS uses secondary data.

Covid-19 vaccination in Brazil started in January/2021. In January/2022, about 70% of the Brazilian population was fully vaccinated. For data analysis, 2020/2021 (COVID-19 outbreak) data were compared to the 2018/2019 data (pre-COVID-19 outbreak). The 2022 data were used to discuss the impact of vaccination on the number of consultations and radiological exams performed for urinary stones in the Brazilian Public Health System.

Results

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A total of 2.224.902 consultations for urinary stones (ICD-10 N20) were performed from January 2018 to December 2022 in the Brazilian Public Health  System (SUS). 51.8% of patients were female and 64.4% ranged from 31 to 60 years of age.

During the COVID-19 outbreak (2020-2021), there was a significant decrease (20.4%) in urinary stone-related elective consultations compared to the preceding years (2018-2019). There have been 344.957 and 351.620 consultations in 2018 and 2019, respectively (total of 696.577), compared to 266.996 and 287.251 in 2020 and 2021, respectively (total of 554.247). In 2022, there have been a total of 331.867 consultations. On the other hand, the number of urgent consultations due to urinary stone disease increased progressively during the same period. (Figure 1).

The total number of consultations (urgent and elective) per year was as follows: 433.851 (2018), 450.603 (2019), 386.111 (2020), 435.437 (2021) and 518.900 (2022). A drop of 7.1% in the total number of consultations was observed comparing the 2018-2019 (pre-COVID) to the 2020-2021 (COVID outbreak) periods.

In 2018 and 2019, 72.288/49.292 (121.580 total) and 74.554/52.317 (126.871 total), CT scans/US were performed, respectively. In 2020 and 2021, 67.028/39.986 (107.014 total) and 72.232/38.829 (111.061 total) CT scans/US were performed, respectively. A drop of 22.4% and 5.1% in the total number of US and CT scans, respectively, was observed comparing the 2020-2021 (COVID outbreak) period to the 2018-2019 (pre-COVID) period. A drop of 12.2% in the total number of radiological exams was observed comparing the 2018-2019 (pre-COVID) to the 2020-2021 (COVID outbreak) periods.

In 2022, 85.619 CT scans and 37.676 US (123.295 total) were performed. 

Conclusion

During the COVID-19 outbreak, the elective (20.4%) and total number of consultations (7.1%) for urinary stones in the Brazilian Public Health System decreased, despite of an increase of the urgent consultations (42%). This may have impacted the number of surgical procedures, as stated by other authors worldwide and in Brazil as well. Regarding the radiological exams, the impact of the COVID-19 outbreak was even more evident (12.2%), because of the lower number of US (22.4%) performed during this period (2020-2021) compared to the pre-COVID outbreak (2018-2019) period.

In 2022, more than 80% of the Brazilian population had been fully vaccinated for COVID-19. This may have positively impacted the number of consultations and radiological exams performed for urinary stones during the year of 2022.

Funding

None

Lead Authors

Carolina de Oliveira Correa, BsC
Hospital Universitario - Universidade de Sao Paulo

Barros Jacson, MsC
Universidade de Sao Paulo

Jose Otoch, MD, PhD
Hospital Universitario - Universidade de Sao Paulo

Joao Amaro, MD, PhD
Faculdade de Medicina de Botucatu - Universidade Estadual Paulista