Nationwide trends and outcomes of transsphenoidal pituitary surgery: A 15-year analysis from the public healthcare system

Background: Transsphenoidal pituitary surgery is the standard approach for sellar lesions worldwide. However, little is known about its epidemiology, outcomes, and economic burden in low- and middle-income countries. We aimed to analyze nationwide trends of transsphenoidal pituitary surgery in Brazil, using 15 years of data from the public healthcare system. Methods: This was a retrospective, population-based study including patients who underwent transsphenoidal pituitary surgery between 2010 and 2024 in Brazil’s Unified Health System (SUS), the public health system. Data were from the national hospital database, covering surgical volume, mortality, length of stay (LOS), and costs. Results: A total of 8,934 surgeries were performed nationwide over 15 years. The Southeast region was responsible for 65% of the surgeries. Surgical volume increased significantly in the Midwest. The median LOS was 11.4 ± 1.2 days, with a progressive decline over time. The average SUS reimbursement was US$878 ± 97 per hospitalization, showing a significant upward trend from 2010 to 2024, with similar values across regions. The overall in-hospital mortality rate was 1.4%. Conclusion: This is the first nationwide study in Latin America to evaluate transsphenoidal pituitary surgeries within a public health system. The findings reveal pronounced regional disparities, with surgical care highly concentrated in the Southeast, while access remains limited in the North and Northeast. Despite demonstrating that the procedure is safe, with low and stable mortality rates, the reimbursement provided by the SUS is substantially lower than international costs, even in the context of longer hospital stays.