Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202401192
Jornal Vascular Brasileiro
Original Article

Effects of the COVID-19 pandemic on thoracic sympathectomies performed on Brazil’s Public Health System

Impacto da pandemia de covid-19 sobre as simpatectomias torácicas realizadas pelo Sistema Único de Saúde

Carolina Carvalho Jansen Sorbello; Felipe Soares Oliveira Portela; Marcelo Fiorelli Alexandrino da Silva; Marcelo Passos Teivelis; Giulia de Payrebrune St Séve Marins Girardi; José Ribas Milanez de Campos; Nelson Wolosker

http://dx.doi.org/10.1590/1677-5449.202401192 J Vasc Bras, vol.24, e20240119, 2025
PDF
Downloads: 0
Views: 42

Abstract

Background: The COVID-19 pandemic affected health resources in Brazil, as priority was given to providing care to those infected. As a result, patients with other pathologies suffered delays in treatment, especially those waiting for elective surgical treatments, such as sympathectomy for hyperhidrosis.

Objectives: To analyze the number of thoracic sympathectomies performed to treat hyperhidrosis on the Brazilian Unified Health System (SUS), their mortality, demographics, length of hospital stay, and associated costs in the periods before, during, and after the peak of the COVID-19 pandemic.

Methods: This is a retrospective cross-sectional study that analyzed the number of video-assisted thoracic sympathectomies performed on the SUS in the 2 years prior to the pandemic (2018 and 2019), the 2 years of peak pandemic (2020 and 2021), and the 2 years after (2022 and 2023). Data on regional distribution, profile of patients, hospitalization, and associated mortality were also analyzed. Figures were extracted from the SUS Department of Informatics (DATASUS) database.

Results: The number of sympathectomies performed in Brazil during 2020 and 2021 was 60% lower than the number recorded in 2018 and 2019, followed by a 30% smaller than expected increase in 2022 and 2023. Half of these procedures were conducted in the Southeast region of the country. The profile of patients was predominantly young women. Hospitalization time, costs, and mortality were stable over the years.

Conclusions: The volume of sympathectomies for treatment of hyperhidrosis in the SUS was severely affected by the COVID-19 pandemic and remains in slow recovery. The regional distribution, demographic profile, hospitalization data, and mortality rate remained stable.

Keywords

big data; hyperhidrosis; thoracoscopy; sympathectomy; public health; COVID-19

Resumo

Contexto: A pandemia de covid-19 afetou os recursos de saúde no Brasil, com a priorização do atendimento aos pacientes infectados. Como resultado, outras doenças sofreram atrasos no tratamento, especialmente os procedimentos cirúrgicos eletivos, como as simpatectomias para hiperidrose.

Objetivos: Analisar o número de simpatectomias torácicas realizadas para o tratamento de hiperidrose no Sistema Único de Saúde (SUS), bem como a taxa de mortalidade, os dados demográficos, o tempo de internação e os custos associados nos períodos antes, durante e após o pico da pandemia de covid-19.

Métodos: Trata-se de um estudo transversal retrospectivo, que analisou o número de simpatectomias torácicas videoassistidas realizadas no SUS nos 2 anos anteriores à pandemia (2018-2019), bem como nos 2 anos de pico (2020-2021) e nos 2 anos posteriores (2022-2023). Também foram analisados a distribuição regional, o perfil dos pacientes, os dados de internação e a mortalidade associada. Os dados foram extraídos do banco de dados do Departamento de Informática do SUS.

Resultados: O número de simpatectomias realizadas em 2020-2021 foi 60% menor do que o registrado em 2018-2019, seguido de um aumento 30% menor do que o esperado em 2022-2023. Metade dos procedimentos ocorreu na região Sudeste. O perfil dos pacientes é de mulheres jovens. O tempo de internação, os custos e a mortalidade se mantiveram estáveis ao longo dos anos.

Conclusões: O volume de simpatectomias para tratamento de hiperidrose no SUS foi extremamente impactado pela pandemia de covid-19 e ainda permanece em lenta recuperação. A distribuição regional, o perfil demográfico, os dados de internação e a mortalidade permaneceram estáveis.

Palavras-chave

big data; hiperidrose; toracoscopia; simpatectomia; saúde pública; covid-19

References

1 Estevan FA, Wolosker MB, Wolosker N, Puech-Leão P. Epidemiologic analysis of prevalence of the hyperhidrosis. An Bras Dermatol. 2017;92(5):630-4. https://doi.org/10.1590/abd1806-4841.20175551. PMid:29166497.

2 Bahar R, Zhou P, Liu Y, et al. The prevalence of anxiety and depression in patients with or without hyperhidrosis (HH). J Am Acad Dermatol. 2016;75(6):1126-33. https://doi.org/10.1016/j.jaad.2016.07.001. PMid:27567033.

3 Wolosker N, Krutman M, Kauffman P, Paula RP, Campos JRM, Puech-Leão P. Effectiveness of oxybutynin for treatment of hyperhidrosis in overweight and obese patients. Rev Assoc Med Bras. 2013;59(2):143-7. https://doi.org/10.1016/j.ramb.2012.11.002. PMid:23582555.

4 Milanez de Campos JR, Kauffman P, Gomes O Jr, Wolosker N. Video-assisted thoracic sympathectomy for hyperhidrosis. Thorac Surg Clin. 2016;26(3):347-58. https://doi.org/10.1016/j.thorsurg.2016.04.010. PMid:27427529.

5 Wei Y, Xu ZD, Li H. Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a meta-analysis. Gen Thorac Cardiovasc Surg. 2020;68(8):746-53. https://doi.org/10.1007/s11748-020-01376-5. PMid:32390086.

6 Loureiro M, Lemos AN Jr, Salvalaggio PRO, Alwazzan M. Minilaparoscopic lumbar sympathectomy with 3 mm instruments for plantar hyperhidrosis. J Vasc Bras. 2020;19:e20190072. https://doi.org/10.1590/1677-5449.180072. PMid:34178057.

7 Kauffman P, Ribas Milanez de Campos J, Wolosker N, et al. Thoracoscopic cervicothoracic sympathectomy: an eight-year experience. J Vasc Bras. 2003;(2):98-104.

8 Loureiro MP, Novais PM, Coelho RM, Paulin JAN. Sexual effects and longterm outcomes of endoscopic lumbar sympathectomy for plantar hyperhidrosis in men: a cross-sectional study. J Vasc Bras. 2024;23:e20240014. https://doi.org/10.1590/1677-5449.202400142. PMid:39421693.

9 Wolosker N, Faustino CB, Silva MFA, Campos JRM, Kauffman P. Current treatment options for craniofacial hyperhidrosis. J Vasc Bras. 2020;19:e20190152. https://doi.org/10.1590/1677-5449.200152. PMid:34211510.

10 Brasil. Ministério da Saúde. Sistema Único de Saúde – SUS [Internet]. Brasília: Ministério da Saúde; 2024 [cited 2024 Nov 22]. https://www.gov.br/saude/pt-br/sus

11 Brasil. Ministério da Saúde. Departamento de Informática do SUS (DATASUS) [Internet]. Brasília: Ministério da Saúde; 2024 [cited 2024 Nov 22]. https://datasus.saude.gov.br/

12 Louzada ACS, Silva MFA, Portugal MFC, et al. Nationwide cross-sectional analysis of endoscopic thoracic sympathectomy to treat hyperhidrosis over 12 years in Brazil: epidemiology, costs, and mortality. Ann Surg. 2023;277(2):e483-7. https://doi.org/10.1097/SLA.0000000000005178. PMid:34417365.

13 Tetteh HA, Groth SS, Kast T, et al. Primary palmoplantar hyperhidrosis and thoracoscopic sympathectomy: a new objective assessment method. Ann Thorac Surg. 2009;87(1):267-74. https://doi.org/10.1016/j.athoracsur.2008.10.028. PMid:19101310.

14 Silva MFA, Louzada ACS, Teivelis MP, et al. Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1,216 patients over 11 years: a cross-sectional study. Sao Paulo Med J. 2022;140(6):775-80. https://doi.org/10.1590/1516-3180.2021.0773.r2.14022022. PMid:36102451.

15 Wolosker N, Campos JR, Kauffman P, Yazbek G, Neves S, Puech-Leao P. Use of oxybutynin for treating plantar hyperhidrosis. Int J Dermatol. 2013;52(5):620-3. https://doi.org/10.1111/j.1365-4632.2012.05746.x. PMid:23590378.

16 Steinman M, de Sousa JHB, Tustumi F, Wolosker N. The burden of the pandemic on the non-SARS-CoV-2 emergencies: a multicenter study. Am J Emerg Med. 2021;42:9-14. https://doi.org/10.1016/j.ajem.2020.12.080. PMid:33429189.

17 Rizzo LV, Wolosker N. Brazil’s COVID-19 response. Lancet. 2020;396(10254):e33. https://doi.org/10.1016/S0140-6736(20)31915-2. PMid:32950095.

18 Dal Poz MR, Levcovitz E, Bahia L. Brazil’s fight against COVID-19. Am J Public Health. 2021;111(3):390-1. https://doi.org/10.2105/AJPH.2020.306122. PMid:33566654.

19 Alexandrino da Silva MF, Oliveira Portela FS, Sposato Louzada AC, Teivelis MP, Amaro E Jr, Wolosker N. National cross-sectional epidemiological analysis of the impact of pandemic COVID-19 on vascular procedures in public health system: 521,069 procedures over 4 years. Ann Vasc Surg. 2024;98:7-17. https://doi.org/10.1016/j.avsg.2023.07.103. PMid:37717819.

20 Fundação Oswaldo Cruz. Autorizações de Internação Hospitalar aprovadas [Internet]. 2024 [cited 2024 Nov 22]. https://tabnet.fiocruz.br/dhx.exe?observatorio/tb_aih.def

21 Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet. 2022;399(10334):1513-36. https://doi.org/10.1016/S0140-6736(21)02796-3. PMid:35279232.

22 Oliveira WK, Cavalcanti LPG, Croda J. Coronavirus disease COVID-19 pandemic and the Declaration of Public Health Emergency in Brazil: administrative and epidemiological aspects. Rev Soc Bras Med Trop. 2022;55:e02272022. https://doi.org/10.1590/0037-8682-0227-2022. PMid:35613222.

23 Cunha MJS, Silva MFA, Souza KP, et al. Effects of COVID-19 outbreak in image-guided biopsies in brazil: an epidemiological study over 13 years and 2 million biopsies. Cardiovasc Intervent Radiol. 2022;45(4):533-5. https://doi.org/10.1007/s00270-022-03062-w. PMid:35112147.

24 Wolosker N, Teivelis MP, Krutman M, et al. Long-term results of the use of oxybutynin for the treatment of axillary hyperhidrosis. Ann Vasc Surg. 2014;28(5):1106-12. https://doi.org/10.1016/j.avsg.2013.12.024. PMid:24512855.

25 Rosin D. COVID-19 effect on surgical care. Isr Med Assoc J. 2022;24(5):332. PMid:35598059.

26 Wolosker N, Teivelis MP, Krutman M, et al. Long-term efficacy of oxybutynin for palmar and plantar hyperhidrosis in children younger than 14 Years. Pediatr Dermatol. 2015;32(5):663-7. https://doi.org/10.1111/pde.12385. PMid:25490865.

27 Wolosker N, Munia MA, Kauffman P, Campos JR, Yazbek G, Puech-Leão P. Is gender a predictive factor for satisfaction among patients undergoing sympathectomy to treat palmar hyperhidrosis? Clinics. 2010;65(6):583-6. https://doi.org/10.1590/S1807-59322010000600004. PMid:20613933.

28 Wolosker N, Krutman M, Campdell TPDA, Kauffman P, de Campos JRM, Puech-Leão P. Oxybutynin treatment for hyperhidrosis: a comparative analysis between genders. Einstein. 2012;10(4):405-8. https://doi.org/10.1590/S1679-45082012000400002.

29 McConaghy JR, Fosselman D. Hyperhidrosis: management options. Am Fam Physician. 2018;97(11):729-34. PMid:30215934.

30 Milanez de Campos JR, Kauffman P, Wolosker N, et al. Axillary hyperhidrosis: T3/T4 versus T4 thoracic sympathectomy in a series of 276 cases. J Laparoendosc Adv Surg Tech A. 2006;16(6):598-603. https://doi.org/10.1089/lap.2006.16.598. PMid:17243877.

31 Lima SO, Machado J No, Fontes LM, Figueiredo MBGA, Santos JM, Santana VR. Evaluation of quality of life (QOL) of young patients with primary hyperhidrosis (PH) before and after endoscopic thoracic sympathectomy (ETS). J Am Acad Dermatol. 2023;88(5):e197-201. https://doi.org/10.1016/j.jaad.2015.10.048. PMid:37069802.

32 Parashar K, Adlam T, Potts G. The impact of hyperhidrosis on quality of life: a review of the literature. Am J Clin Dermatol. 2023;24(2):187-98. https://doi.org/10.1007/s40257-022-00743-7. PMid:36622502.

33 Wolosker N, Yazbek G, de Campos JR, et al. Quality of life before surgery is a predictive factor for satisfaction among patients undergoing sympathectomy to treat hyperhidrosis. J Vasc Surg. 2010;51(5):1190-4. https://doi.org/10.1016/j.jvs.2009.11.078. PMid:20299178.
 

Submitted date:
08/26/2024

Accepted date:
10/06/2025

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
6984e996a953950d0a10bfc4 jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2026 All rights reserved.

J Vasc Bras

Share this page
Page Sections