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

Omar Asdrúbal Vilca Mejia,Pablo Maria Alberto Pomerantzeff,Marcos Gradim Tiveron,Valquíria Pelisser Campagnucci,Walter José Gomes,Marcelo Arruda Nakazone,Jorge Passamani Zubelli,Roberto Rocha E Silva,Luís Roberto Palma Dallan,Gabrielle Barbosa Borgomoni,Luiz Augusto Ferreira Lisboa,Rafael Ângelo Tineli,Marco Antonio Praça Oliveira,Alfredo José Rodrigues,Orlando Petrucci Junior,Fábio Biscegli Jatene,Salil Deo

doi:10.1371/journal.pone.0238737

Abstract

ObjectivesThe 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.MethodsA total of 11 sites in the state of São 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.ResultsA 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).ConclusionsThe REPLICCAR registry might stimulate the creation of other cardiac surgery registries in developing countries, ultimately improving the regional quality of care provided to patients.

Highlights

Multicenter registries in cardiac surgery constitute the basis for most of the progress achieved in the United States and the European Union [1, 2]
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 insulindependent diabetes, and 19 individuals had a positive diagnosis of Chagas disease
When evaluating the prediction performance, we found that São Paulo risk score (SPScore) outperformed EuroSCORE II and Society of Thoracic Surgeons risk score (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

Summary

Introduction

Multicenter registries in cardiac surgery constitute the basis for most of the progress achieved in the United States and the European Union [1, 2]. In a state where up to 80% of all cardiac surgery procedures are reimbursed by the federal Unified Health System (SUS), development of regional data collection mechanisms for QI and safety is essential to serve as a basis for clinical guidelines and healthcare policies. EuroSCORE II was published in 2012 [4] and was constructed with a dataset that includes over 20000 patients from 43 countries worldwide, mostly in Europe. This revised model was criticized for underestimating mortality from cardiac surgery compared to observed mortality. Validation studies have shown contradictory results; the only paper published in Brazil showed a failure in calibration in a single-center study [6]

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