Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2020 Apr;114(4):603-612. doi: 10.36660/abc.20190736. Epub 2020 Feb 14.
The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes.
To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School (InCor-HCFMUSP).
An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures.
A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001).
In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.
心血管手术（CVS）目前面临的挑战是提高日益严重的患者的治疗效果。在这方面，持续质量改进（CQI）计划已经对结果产生了影响。
评估心血管手术的发病率和死亡率的演变，以及圣保罗大学医学院临床心脏研究所附属医院（InCor-HCFMUSP）的当前治疗结果。
对 Incor 进行的心血管手术的结果进行分析，时间范围为 1984 年 1 月至 2019 年 6 月。我们观察了 5 个时间段内的手术量和死亡率：第 1 阶段（1984-1989 年），第 2 阶段（1990-1999 年），第 3 阶段（2000-2007 年），第 4 阶段（2008-2015 年）和第 5 阶段（2016-2019 年）。2015 年至 2016 年期间实施了 CQI 计划。该分析包括手术总数和最常见手术的演变。
共进行了 105,599 例 CCV 手术，平均每年有 2,964 例手术，死亡率为 5.63%。将第 4 阶段和第 5 阶段进行比较时，手术总量的平均全球水平从 2,943 增加到 3,139（p = 0.368），旁路移植术（CABG）从 638 增加到 597（p = 0.214），心脏瓣膜手术从 372 增加到 465（p = 0.201），先天性心脏病手术从 530 增加到 615（p = 0.125）。全球平均死亡率从 7.8%降至 5%（p < 0.0001）；CABG 手术中，从 5.8%降至 3.1%（p < 0.0001）；心脏瓣膜手术中，从 14%降至 7.5%（p < 0.0001），先天性心脏病手术中，从 12.1%降至 9.6%（p < 0.0001）。
尽管手术量最近有增加的趋势，但研究组的手术死亡率却显着下降。在实施 CQI 计划后，死亡率更接近国际标准。
