Pilonidal Disease: A Brazilian epidemiological study with an overview of 45,000 surgeries performed in the Unified Health System

INTRODUCTION: Pilonidal disease (PD) is a chronic inflammatory disorder affecting the skin and subcutaneous tissues of the sacrococcygeal region, with a predominant impact on young adults. Although there have been considerable advances in surgical management, national-level epidemiological data on PD in Brazil remain scarce. METHODS: We conducted a retrospective, descriptive, population-based study analyzing all surgical procedures for PD recorded in Brazil's public health system (SUS) from January 2014 to December 2023. Data were extracted from the DATASUS platform, using specific procedural codes for pilonidal sinus. Prevalence rates per 100,000 inhabitants were calculated utilizing population estimates from the Brazilian Institute of Geography and Statistics (IBGE). Temporal trends were assessed through linear regression analysis, and regional comparisons were performed using Pearson's chi-square test with Bonferroni correction. RESULTS: Throughout the ten-year period, 45,915 patients underwent surgery for PD, yielding a mean prevalence of 2.42 cases per 100,000 inhabitants. The highest regional prevalence was observed in the South, while the North had the lowest rates. An overall upward trend in surgical intervention rates was noted, particularly from 2014 to 2019, with a temporary decline during the COVID-19 pandemic (2020-2021) and subsequent recovery. Significant regional disparities were evident, suggesting that healthcare infrastructure and access differences may contribute to these patterns. CONCLUSION: Pilonidal sinus disease (PSD) has shown a steady rise in surgical cases in Brazil, particularly in the South and Southeast regions. Despite lower national prevalence compared to high-income countries, the increasing trend highlights growing public health concerns and significant regional disparities.