Brazilian System for Cardiac Operative Risk Evaluation - BraSCORE CABG

• Grant number: 24/11761-7
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• Start date: January 01, 2025
• End date: June 30, 2026
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Omar Asdrúbal Vilca Mejía
• Grantee: Bianca Maria Maglia Orlandi
• Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

The set of relevant demographic and clinical information of affected patients, at the level of specific strata and in correlation with the required sets of resources, represents the possibility of adapting, improving, and innovating in cardiac surgery quality programs. Along this path, the search for implementing large databases to build continuous improvement cycles becomes the basis of the entire process. In Brazil, where structural and socioeconomic differences are significant, the standardization and sustainability of a large database becomes a major challenge. For example, the REPLICCAR project (São Paulo Registry of Cardiovascular Surgery) and the BYPASS Registry built to identify opportunities for improvement were temporary. The lack of a multicenter registry for continuous collection makes it difficult to understand risk-adjusted results for patients, and especially, to implement cost-effective quality initiatives. For example, in 2022, the Ministry of Health launched the QualiSUS Cardio program, where hospital reimbursement began to look beyond surgical volume, to indicators of mortality, length of stay, and readmission after heart surgery. Changes like this already happen in several scenarios where paying sources, whether public or private, seek reimbursement through value-based models, but for this to happen the results would need to be adjusted to the patient's risk. Otherwise, hospitals that care for more serious patients would be harmed. This study aimed to develop the CABG - BraSCORE, a risk score to stratify patients referred for myocardial revascularization surgery to better adjust the results to the mortality patient's risk in the search for continuous improvement of cardiac surgery programs in the country.