Analysis of all Video-Assisted Thoracic Sympathectomy for Hyperhidrosis over 9 Years in Brazil: Trends, Costs, and In-Hospital Mortality over 200 Million Inhabitants.

BACKGROUND

Primary hyperhidrosis (HH) causes substantial functional and psychosocial impairment. While anticholinergic therapy has become first-line treatment, video-assisted thoracic sympathectomy (VATS) remains the only definitive option for patients with refractory disease. Large-scale, real-world data on the safety and utilization of VATS for HH at a national level remain limited.

METHODS

We conducted a nationwide retrospective analysis including all patients who underwent VATS for HH in Brazil between 2015 and 2023. Data were obtained from publicly available governmental databases encompassing both public and private health-care systems. Procedure volumes, demographic characteristics, regional distribution, reimbursement, in-hospital mortality, and health-care sector differences were analyzed.

RESULTS

A total of 26,980 VATS procedures for HH were performed during the study period. Most patients were female (64.5%) and aged 15-39 years (82.7%). Procedures were predominantly performed in the private health-care system (75.3%), with marked regional concentration in the Southeast (48.3%) and South (29.5%) regions. Overall in-hospital mortality was extremely low (0.048%) and did not differ significantly between public and private sectors. Despite similar safety profiles, the mean cost per procedure in the private system was substantially higher, resulting in more than 90% of total national expenditures.

CONCLUSION

In this nationwide cohort of nearly 27,000 procedures, VATS sympathectomy for primary HH demonstrated a low mortality rate across both public and private health-care systems, supporting its role as a safe definitive surgical therapy when appropriately indicated. The marked disparities in access and cost highlight important system-level differences but do not appear to compromise procedural safety.