Postectomia clássica versus dispositivo plástico: identificando e gerenciando custos operacionais

Abstract

Introduction: The surgical treatment for phimosis can be done using various surgical techniques, including the dissections technique and the plastic device technique. As the procedure process implicated in costs ever increasing and less resource to the public health care system, this research aimed to identify and compare the final costs between the different circumcision techniques, evaluating and comparing the inputs` consumption variability, the operational expenses and the cost related to the post operation complication. Patients and methods: The research included 56 boys between 02 and 13 years of age that were randomly divided into 2 groups: Dissection circumcision (C) and plastic device circumcision (P). The children were observed since their hospital admission until discharge from the hospital and them until their discharge from urological follow-up (D60). The anesthetic technique was standardized and all subjects underwent inhalation sedation and dorsal nerve penile block). It was identified and assessed all input consumption (material and medicines) during surgery and postoperative time. Then, the data were calculated adding to the hospital taxes and day clinics. Results: The weight of the subjects was even between the groups. The time spent to perform circumcision on group C was longer than the time for the P group (p = 0.001). Time to surgical stitches break down and plastic device was not noted difference between the groups (p = 0.605). The trans-operative cost (surgery and anesthesia recovery room) was higher in group P (R $ 316.0 ± 9.3) than in group C (R $ 310.4 ± 9.5) (p = 0.0005). During the late postoperative period the cost of inputs (materials and medicines) and consultation in day clinic pediatric was similar between groups. The final cost was also higher in group P (R$347,5 ± 9,2) than group C (R$341,9 ± 9,5) (p = 0,0008). We found no differences in complication rates. Conclusion: The classical techniques of circumcision and plastic device offer the same efficacy in the treatment of phimosis. The surgery using plastic device is more expense, but the management of costs should not take into account only the procedure of lesser value because, in the case of circumcision, the more expensive surgery uses the operating room for a shorter time, allowing the schedule of more surgeries per operating room.