Geographic Disparities in Transsphenoidal Pituitary Surgery in the State of São Paulo, Brazil: An Analysis of the Public Healthcare System - 05/11/26

Doi : 10.1016/j.neuchi.2026.101895

Bruno Pellozo Cerqueira ^a,⁎ , Samantha Xavier Souza ^b, Victoria Taborda Bartasevicius ^b, Afonso Dutra-Melo ^a, Bruna Lisboa Vale ^a, Francisco Vaz-Guimarães ^a, Samuel Tau Zymberg ^a

^a Department of Neurology and Neurosurgery, Division of Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil

^b Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil

^⁎ Corresponding author at: Escola Paulista de Medicina, Universidade Federal de São Paulo, 715 Napoleão de Barros St, 6th Floor, Hospital São Paulo Building, Vila Clementino, São Paulo, SP 04024-002, Brazil. Escola Paulista de Medicina Universidade Federal de São Paulo 715 Napoleão de Barros St 6th Floor Hospital São Paulo Building Vila Clementino São Paulo SP 04024-002 Brazil

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 05 November 2026

Highlights

•	Transsphenoidal surgery was highly concentrated in a few referral centers
•	Marked geographic disparities were observed across health regions
•	Hospital stay and intensive care use varied substantially among regions
•	Financial reimbursement differed significantly between institutions
•	Mortality remained low despite regional and institutional disparities

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Abstract

Objective

To analyze the surgical volume, geographic distribution, healthcare indicators, and costs of transsphenoidal surgeries performed within the public healthcare system in the state of São Paulo over a 15-year period.

Methods

A retrospective study based on publicly available secondary data obtained from the São Paulo State Health Department TabNet database. Hospitalizations related to transsphenoidal hypophysectomy performed between 2010 and 2024 were included. Surgical volume, regional distribution, length of hospital stay, intensive care unit stay (ICU), mortality, and costs were evaluated.

Results

A total of 4,086 surgeries were performed, with an annual mean of 272 ± 53 procedures, predominantly concentrated in Region 1 (68%). The mean hospital length of stay was 9.4 ± 0.9 days, showing a decreasing trend over time in some regions, whereas the mean ICU stay was 2.1 ± 0.3 days, with an increasing trend statewide. Significant regional differences were observed regarding hospital length of stay, ICU stay, and costs (p < 0.001). The mean cost per hospitalization was US$ 852 ± 93, with an upward trend throughout the study period. Overall mortality was 1.1%, remaining low and stable over time. Considerable heterogeneity was observed among high-volume centers, with differences in healthcare and financial indicators.

Conclusion

Transsphenoidal surgeries in the state of São Paulo are concentrated in higher-volume regions and centers, with substantial heterogeneity in healthcare and financial indicators. Nevertheless, mortality remains low, reinforcing the safety of this procedure within the public healthcare system.

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Keywords : Pituitary Neuroendocrine Tumor, Pituitary Adenoma, Public Healthcare System, Transsphenoidal Surgery, Pituitary Surgery