Validation and quality measurements for STS, EuroSCORE II and a regional risk model in Brazilian patients

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Vilca Mejia, Omar Asdrubal ; Borgomoni, Gabrielle Barbosa ; Zubelli, Jorge Passamani ; Palma Dallan, Luis Roberto ; Alberto Pomerantzeff, Pablo Maria ; Praca Oliveira, Marco Antonio ; Petrucci Junior, Orlando ; Tiveron, Marcos Gradim ; Nakazone, Marcelo Arruda ; Tineli, Rafael Angelo ; Campagnucci, Valquiria Pelisser ; Rocha e Silva, Roberto ; Rodrigues, Alfredo Jose ; Gomes, Walter Jose ; Ferreira Lisboa, Luiz Augusto ; Jatene, Fabio Biscegli ; REPLICCAR Study Grp

• Tipo de documento: Artigo Científico
• Fonte: PLoS One; v. 15, n. 9, p. 16-pg., 2020-09-10.

Resumo

Objectives The objectives of this study were to describe a novel statewide registry for cardiac surgery in Brazil (REPLICCAR), to compare a regional risk model (SPScore) with EuroSCORE II and STS, and to understand where quality improvement and safety initiatives can be implemented. Methods A total of 11 sites in the state of Sao Paulo, Brazil, formed an online registry platform to capture information on risk factors and outcomes after cardiac surgery procedures for all consecutive patients. EuroSCORE II and STS values were calculated for each patient. An SPScore model was designed and compared with EuroSCORE II and STS to predict 30-day outcomes: death, reoperation, readmission, and any morbidity. Results A total of 5222 patients were enrolled in this study between November 2013 and December 2017. The observed 30-day mortality rate was 7.6%. Most patients were older, overweight, and classified as New York Heart Association (NYHA) functional class III; 14.5% of the patient population had a positive diagnosis of rheumatic heart disease, 10.9% had insulin-dependent diabetes, and 19 individuals had a positive diagnosis of Chagas disease. When evaluating the prediction performance, we found that SPScore outperformed EuroSCORE II and STS in the prediction of mortality (0.90 vs. 0.76 and 0.77), reoperation (0.84 vs. 0.60 and 0.56), readmission (0.84 vs. 0.55 and 0.51), and any morbidity (0.80 vs. 0.65 and 0.64), respectively (p<0.001). Conclusions The REPLICCAR registry might stimulate the creation of other cardiac surgery registries in developing countries, ultimately improving the regional quality of care provided to patients. (AU)

• Processo FAPESP: 12/51229-5 - Estratificação de risco cirúrgico como instrumento de inovação em programas em cirurgia cardíaca no Sistema Único de Saúde do estado de São Paulo
• Beneficiário: Luiz Augusto Ferreira Lisboa
• Modalidade de apoio: Auxílio à Pesquisa - Pesquisa em Políticas Públicas para o SUS