Economic Impact of Knee Revision Arthroplasty in the Brazilian Public Health System (SUS): A Comparative Analysis of Hospital Costs (2018-2025)
F. Masukawa, S.T. Lipski, E.C. Artero, M.G. Casarini, D.D.S. FerreiraObjectives:
To compare the total amount spent by the Brazilian Public Health System (SUS) on primary surgeries with that of revision surgeries between 2018 and 2025. Methods: This observational, ecological, cross-sectional study was conducted using data collected from the Department of Informatics of the Unified Health System (DATASUS) database on knee prosthesis revision surgery between 2018 and 2025. The variable used was: year. The data were tabulated for statistical analysis.
Results:
There were 71,891 primary and 6,824 revision hospitalizations (9.5%). Procedures rose from 8,386 (2018) to 16,090 (2025). Primary costs surpassed R$424 million, revisions R$61 million (12.6% of total). Average cost was R$5,906.48 (primary) versus R$8,961.51 (revision); each revision equals the cost of 1.52 primary surgeries.
Discussion:
Revision surgeries cost 52% more, reflecting higher complexity. A 1% annual reduction in revisions could save over R$4 million, allowing expansion of access to primary surgeries, which remains lower in Brazil compared to developed countries. Measures such as infection prevention protocols, staff training, and outcomes monitoring should be seen as strategic investments.
Conclusion:
Revision total knee arthroplasties (TKA) account for 9.5% of procedures in the Brazilian public health system (SUS), but consume 12.6% of resources. Reducing these surgeries by 1% could save more than R$4 million and expand primary arthroplasties without increasing the budget, showing that improving initial surgery is crucial for sustainability and equity in the SUS.