PLoS ONE (Jan 2020)

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

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

DOI
https://doi.org/10.1371/journal.pone.0238737
Journal volume & issue
Vol. 15, no. 9
p. e0238737

Abstract

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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 (pConclusionsThe REPLICCAR registry might stimulate the creation of other cardiac surgery registries in developing countries, ultimately improving the regional quality of care provided to patients.