ABC | Volume 114, Nº4, April 2020

Original Article Mejia et al. Quality, the new era of cardiovascular surgery Arq Bras Cardiol. 2020; 114(4):603-612 Table 1 – Number of Procedures per Surgical Group at the InCor during the 5 periods Period 1 Period 2 Period 3 Period 4 Period 5 Total 2,122 2,812 3,806 2,943 3,139 Groups Selected Coronary 856 1,013 1,106 638 597 Valve 400 434 597 372 465 Congenital 403 497 685 530 615 Arrhythmias 238 606 1,018 1,146 1,165 There was a decrease of 42.3% between the 3rd and 4th periods (p = 0.0002), and of 6.4%, between the 4th and 5th periods (p = 0.2141). In valve surgeries, there was an increase of 8.5% between the 1st and 2nd periods (p = 0.1471), and of 37.6%, between the 2nd and 3rd periods (p = 0.0001). This increment decreased in the same proportion between the 3rd and 4th periods (p = 0.0009). However, there was an increase of 24.9% between the 4th and 5th periods (p = 0.2019). In congenital surgeries, there was an increment of 23.4% between the 1st and 2nd periods (p = 0.0020), and of 37.8%, between the 2nd and 3rd periods (p = 0.0077). There was a decrease of 22.7% between the 3rd and 4th periods (p = 0.0312), and an increase of 16.1%, between the 4th and 5th periods (p = 0.1250). In arrhythmia surgeries, there was an increase of 154.6% between the 1st and 2nd periods (p = 0.0001), 68% between the 2nd and 3rd periods (p = 0.0001), 12.6% between the 3rd and 4th periods (p = 0.0084), and of 1.6% between the 4th and 5th periods (p = 0.8081) (Table 1). In the total mortality analysis, although there was a decrease in mortality of 1% between the 1st and 2nd periods (p = 0.0001), there was an increase of 0.1% between the 2nd and 3rd periods (p = 0.5227), and of 2.9% between the 3rd and 4th periods (p = 0.0001). However, there was a decrease of 2.8% between the 4th and 5th periods (p = 0.0001), which resulted in a decrease of 0.8% between the 1st and 5th periods (0.0051). In relation to CABG surgery, there was a decrease inmortality of 0.1% between the 1st and 2nd periods (p = 0.7088), with an increase of 0.5% between the 2nd and 3rd periods (p = 0.1072), and of 1% between the 3rd and 4th periods (p = 0.0121). Nonetheless, there was a decrease of 2.6% between the 4th and 5th periods (p = 0.0001), achieving a decrease of 1.3% between the 1st and 5th periods (p=0.0092). In valve heart surgeries, there was an increase in mortality of 0.3% between the 1st and 2nd periods (p = 0.6693), of 0.5% between the 2nd and 3rd periods (p = 0.4174), and of 5.5% between the 3rd and 4th periods (p = 0.0001). However, there was a decrease of 6.5% between the 4th and 5th periods (p = 0.0001), ending up with a decrease of 0.2% between the 1st and 5th periods (p = 0.8946). In congenial surgeries, there was a decrease in mortality of 0.9% between the 1st and 2nd periods (p = 0.1993), and of 2.7% between the 2nd and 3rd periods (p = 0.0001). Although there was an increase in mortality of 6.9% between the 3rd and 4th periods (p = 0.0001), there was a decrease of 2.5% between the 4th and 5th periods (p = 0.0017). When we compared the 1st and 5th periods, there was an increase in mortality of 0.7% (p = 0.3943). In arrhythmia surgeries, there was a decrease in mortality of 1.2% between the 4th and 5th periods (p = 0.0001). We could not accurately retrieve the data on mortality of the arrhythmia surgeries performed in the 1st, 2nd and 3rd periods. (Table 2) The graphs of global, coronary, valve, and congenital volume and mortality in > 35 years of the InCor are shown in Figures 1, 2, 3 and 4, respectively. Additionally, we provided the annual volume (Table 3) and mortality (Figure 5) rates of the most complex and most frequently perfomed procedures in cardiovascular surgery since 2008: Acute Aortic Dissection, Congenital, Isolated CABG, CABG + Valve, Aortic Valve, Mitral Valve, and Aortic Valve + Mitral Valve. For didactic purposes, we decided to compare these procedures in the 4th and 5th periods as well. Therefore, in Acute Aortic Dissection, the average annual volume increased 66% (p = 0.1060) and mortality decreased 11.2% (p=0.0016). In CABG + Valve, the average annual volume decreased 22.4% (p = 0.1481) and mortality reduced 12.1% (p = 0.0001). In Mitral Valve surgery, the average annual volume increased 34.1% (p = 0.1535) and mortality reduced 6.4% (p < 0.0001). In Aortic Valve surgery, the average annual volume increased 14.6% (p = 0.1481) and mortality reduced 6.7% (p < 0.0001). In Mitral Valve surgery + Aortic valve, the average annual volume increased 22% (p = 0.2688) and mortality reduced 11.9% (p < 0.0001) (Figure 5). We also analysed two procedures considered the state of the art in cardiovascular surgery: Off-pump CABG surgery (OPCAB) and Valve Repair, for periods 4 and 5. The annual average volume of OPCAB decreased 49.8% (p = 0.0040) and mortality increased 0.8% (p = 0.7018). Still, the annual average volume of Valve Repairs reduced 5.7% (p = 0.8081), but mortality reduced 3.8% (p = 0.0427). Discussion We carried out a time series analysis of the volume and mortality in cardiovascular surgeries in > 35 of the InCor, one of the greatest intitutions in Latin America which, in 2016, established its CQI Program. These information were obtained 605