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Heart surgery programs innovation using surgical risk stratification at the São Paulo State Public Healthcare System:
Omar Asdrúbal Vilca Mejía1, Luiz Augusto Ferreira Lisboa, Luis Alberto Oliveira Dallan
1University of São Paulo Medical School (FMUSP), Beneficência Portuguesa Hospital of São Paulo, São Paulo, SP, Brazil. omarvmejia@sbccv.org.br
Insights
This study aims to improve cardiac surgery risk assessment by developing the Sao Paulo System for Cardiac Operative Risk Evaluation (SP-SCORE). The new model will enhance resource allocation and healthcare sustainability for cardiovascular procedures.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- Cardiovascular diseases are a major cause of morbidity and mortality.
- Cardiac surgery significantly impacts disease outcomes.
- Accurate risk assessment is crucial for resource allocation and healthcare innovation.
Purpose of the Study:
- To remodel the existing "InsCor" risk score into the Sao Paulo System for Cardiac Operative Risk Evaluation (SP-SCORE).
- To develop a more accurate risk prediction model for cardiac surgery in Brazil.
- To support the sustainability and financing of cardiovascular surgery programs within the SUS-SP.
Main Methods:
- Utilizing 10 variables from the InsCor model and 8 additional variables relevant to the Brazilian context.
- Employing a bootstrap technique and automated variable selection (stepwise) for model development.
- Applying multiple logistic regression to create a parsimonious predictive model.
Main Results:
- The SP-SCORE aims to better reflect the complexity of cardiac surgical care.
- The model will identify key demographic and clinical factors associated with resource utilization.
- Primary endpoints for evaluation include morbidity and mortality rates.
Conclusions:
- The SP-SCORE is expected to enhance the equitable allocation of resources for cardiac surgery.
- The model will contribute to increased access and effectiveness of cardiovascular surgical programs.
- This initiative will aid in characterizing resource magnitude and impact within the SUS-SP.
Abstract:
Cardiovascular diseases represent the greatest burden of morbidity and mortality for the health system and cardiac surgery has an important impact on their resolutivity. The association and correlation of patients' demographic and clinical relevant information with the resources required for each stratum represent the possibility to adapt, improve and innovate into the healthcare programs. This project aims to remodel the "InsCor" risk score for the formulation of the SP-SCORE (Sao Paulo System for Cardiac Operative Risk Evaluation) in order to better reflects the complexity of cardiac surgical care. The participating hospitals include the Health Technology Assessment Centers in of the Health Secretariat' HTA Network of São Paulo State (HTA-NATSs / SES-SP). The SP-SCORE will use 10 variables of the InsCor model and others 8 variables with presumed influence in Brazil. The primary endpoints are morbidity and mortality. Bootstrap technique besides automated selection of variables (stepwise) will be used to develop a parsimonious model by multiple logistic regression. This project will contribute for the SUS-SP regionalized health-care (RRAS) sustainability and financing of the CABG and/or heart valve surgery programs promoting equitable allocation, increasing access and effectiveness, as well as characterizing the magnitude of available resources and its impact.
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