Analysis of all video-assisted thoracic sympathectomy over 9 years in Brazil: trends, costs and mortality over 200 million inhabitants.

BackgroundHyperhidrosis (HH) is characterized by excessive sweating beyond thermoregulatory requirements and can significantly impair quality of life. Although oxybutynin has become an effective first-line therapy, video-assisted thoracic sympathectomy (VATS) remains the only definitive option for refractory cases. The availability of nationwide public and private healthcare datasets in Brazil enables a comprehensive assessment of national procedural trends on a continental scale. MethodsWe performed a retrospective nationwide analysis of all VATS procedures for HH conducted in Brazil between 2015 and 2023. Data were extracted from publicly available governmental databases covering both the public and private healthcare systems. Procedure rates were evaluated by year, geographic region, sex, and age group. Temporal patterns and differences between healthcare sectors were analyzed. ResultsA total of 26,980 VATS procedures were performed during the study period, with the private sector accounting for 75.25% of surgeries. Regionally, the Southeast (48.28%) and South (29.51%)--the most economically developed areas of the country--concentrated the majority of procedures. Women represented 64.5% of operated patients, and most surgeries were performed in individuals aged 15-39 years (82.74%). The mean cost per procedure in the private system was 4.2 times higher than in the public system (US$1,351.94 vs. US$351.27, p < 0.001), and the private sector accounted for more than 90% of total national expenditures. The overall mortality rate was 0.048%, with no significant difference between healthcare sectors. ConclusionsThis study provides the first nationwide evaluation of VATS performed for HH across Brazils public and private systems. Based on 26,980 procedures carried out between 2015 and 2023, most surgeries occurred in the private sector and predominantly involved women and young adults aged 15-39 years. Although mortality was low and similar across systems, procedure costs were substantially higher in the private sector, which accounted for the vast majority of national expenditures.