Economic and clinical impact of long waiting lists for scoliosis surgery

Abstract

Objectives: To evaluate the implications of waiting lists for Adolescent Idiopathic Scoliosis (AIS) surgery in the Unified Health System (SUS), from the perspective of managers and physicians, and to propose cost-effective solutions. Methods: The study was conducted in two stages: (1) an electronic questionnaire was sent to identify the main challenges related to waiting lists and (2) a focus group was organized to discuss proposals for reducing and eliminating these lists. Results: Long waiting lists for AIS surgery in the SUS are mainly caused by the high cost of implant materials, low medical remuneration, and difficulties in accessing adequate referral centers. Delayed treatment leads to progression of the deformity, increasing the complexity and cost of surgical procedures and negatively impacting patients’ quality of life. In addition, the judicialization of health has been a frequent consequence of these delays. Conclusions: Current prioritization criteria for surgical treatment are inadequate, often based only on waiting time, without considering the severity of the case. Structural reforms in the SUS are necessary, including the creation of a national platform for better screening and prioritization, as well as improvements in infrastructure and remuneration of health professionals. Level of Evidence V; Expert Opinion.