Surgical Complexity, Disease Severity, and Direct Healthcare Costs of Endometriosis in the Brazilian Public Health System: A Cross-Sectional Analysis

STUDY OBJECTIVE: The objective was to evaluate the clinical and demographic characteristics of patients undergoing endometriosis surgery in the public healthcare system, estimate the direct costs related to low- and high-complexity procedures, and identify the principal clinical and procedural determinants of increased surgical expenditure. DESIGN: Cross-sectional study conducted between October 2022 and June 2023. SETTING: These patients underwent laparoscopic surgery for endometriosis treatment at a tertiary center in São Paulo, Brazil. PATIENTS: Ninety-seven women aged 18 years or older who underwent surgical intervention care through the Brazilian Unified Health System (SUS). INTERVENTIONS: Participants underwent either simple or complex surgeries, based on criteria American Association of Gynecologic Laparoscopists (AAGL): (1) AAGL I-II (n = 37), and (2) AAGL III-IV (n = 60). MEASUREMENTS AND MAIN RESULTS: Complex surgical procedures were associated with a mean cost increase of 31% (p = .024). Length of hospital stay was also independently associated with higher costs, corresponding to an average increase of β = 0.089 per day (p <.001). For major complications, the estimated cost increase was approximately 88% (p = .004). In women undergoing complex surgery, with an AAGL score IV, age 4 days, the estimated cost may reach USD 7987.87 with a 98.6% probability. CONCLUSION: This study conducted with patients from the Brazilian Unified Health System in a tertiary public hospital, shows that disease severity, surgical complexity, length of stay and complications significantly impact the direct costs of endometriosis surgeries. Although these findings derive from a single institution, they underscore the importance of evidence-based surgical planning by providing empirical cost estimates and their variability. These data may inform cost evaluations in comparable settings and support strategic planning for similar patient populations and healthcare systems.