O Custo do Paciente Queimado no SUS: Análise de Mundo Real com Ênfase em Infecções e Recursos Terapêuticos

Abstract

Introduction (with objective): Burns represent one of the most serious and complex traumas, requiring intensive, prolonged, and high-cost care for the hospital system (1). This study analyzes the direct costs of severely burned patients from the perspective of the Brazilian Unified Health System (SUS), in a tertiary hospital. The objective was to analyze the direct healthcare costs associated with the hospitalization of adult patients with severe burns in 2024 in a high-complexity hospital unit, with emphasis on medications, invasive devices, and high-cost dressings, considering clinical factors such as infections and the use of invasive devices. Material and Method: Retrospective observational study, with a quantitative approach and analysis of secondary data via electronic medical records. Direct costs during hospitalization in Intensive Care Units (ICU) were analyzed considering the purchase price from the price record of the hospital's computerized system. The time horizon was restricted to the hospitalization period (short term), dispensing with the application of a discount rate. The comparators were defined by bacterial resistance profile (with Multidrug-Resistant Bacteria (MDR) vs. without MDR), and Burned Body Surface Area (BBSA). Statistical analysis was descriptive (means and frequencies). Results: 87 patients were included, 77.0% male, mean age 43 years. The average length of stay was 26 days in the ICU and 33 days in the hospital. 31.0% died, 52.9% were discharged, and 16.1% were transferred. The total cost was R$1,029,180.58, comprising R$94,921.70 in dressings, R$913,900.43 in medications (R$326,389.42 for sedation and analgesia, R$321,398.07 for antimicrobials, and R$266,112.94 for the remainder), and R$20,358.45 in devices. BMR were found in 40 patients, 75.5% were male, with an average age of 44.3 years. They remained hospitalized for an average of 37 days in the ICU and 42.9 days in the hospital. 50.0% died, 35.0% were discharged, and 15.0% were transferred. The total cost was R$755,926.74, comprising R$14,837.72 in dressings, R$730,183.46 in medications (R$258,822.84 for sedation and analgesia, R$294,757.04 for antimicrobials, and R$176,603.58 for the remainder), and R$10,905.56 in devices. The most expensive antimicrobials were Ceftazidime+Avibactam and Meropenem. The most prevalent bacteria were Acinetobacter baumannii and Enterobacterales, both resistant to carbapenems. Of the 47 patients without MDR-B, 80.9% were male, with an average age of 42 years. They remained hospitalized for an average of 17 days in the ICU and 25 days in the hospital. 14.9% died, 68.1% were discharged, and 14.0% were transferred. The total cost was R$273,253.84, including R$80,083.98 for dressings, R$183,716.97 for medications (R$67,566.58 for sedation and analgesia, R$26,641.03 for antimicrobials, and R$89,509.36 for the remainder), and R$9,452.89 for devices. The average daily cost in the ICU increased according to the TBSA range: R$265.64 (≤20%), R$349.52 (21–40%), and R$736.15 (>40%). Conclusions: The subgroup of patients with BMR presented worse clinical and economic outcomes, with longer hospital stays, higher mortality, and a concentration of approximately 73% of the total costs in the sample. Additionally, the daily cost in the ICU almost tripled in patients with SCQ >40%. Monitoring these indicators is fundamental to optimizing budget planning in the SUS (Brazilian Public Health System).