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 2 – Mortality Rates per Surgical Group of the InCor during the 5 periods Period 1 Period 2 Period 3 Period 4 Period 5 Total 5.79% 4.75% 4.86% 7.78% 4.99% Groups Selected Coronary 4.44% 4.29% 4.79% 5.78% 3.14% Valve 7.63% 7.95% 8.44% 13.96% 7.47% Congenital 8.85% 7.94% 5.27% 12.13% 9.60% Arrhythmias 2.15% 0.94% from the InCor database, which was founded in 1984, at the same time that the New York State database was established. 10 This is also the period when a series of risk scores began to arise all over the world, with the purpose of stratifying patients, adjusting risk and monitoring the outcomes. 11 These initiatives came at a time when patients had more comorbid conditions and, at the same time, the most complex surgeries were influenced by the increase in life expectancy. 12 It was the ideal scenario to start measuring the outcomes and optimizing the strategies. Perhaps one of the highest impact projects on outcomes continuous improvement has been the creation of the EuroSCORE 13 and the STS score 14 which, through the estimation of expected mortality, allowed us to plan, prepare and even look for new treatment alternatives for the patients. The adoption of these instruments in surgical practice enabled the phenomenon to develop. While the centers started to make their measurements, the outcomes observed continued to improve to the extent that the scores had to be recalibrated in order to survive. 15 At the InCor, the measurements started to be taken in 2007 with the incorporation of the EuroSCORE and the 2000 Bernstein-Parsonnet model, for estimation of expected mortality. 4 These models, which were validated first, were used by the INCOR to elaborate its own model: the InsCor. 5 In the evolution of outcomes, this corresponds to period 4 of the present analysis. It was in this period that the culture of data and outcomes measurements began to consolidate, although a decrease in the surgical volume at the InCor, both in general surgery and in the subgroup ones, resulted in a proportional increase in surgical mortality rates. In addition, Figure 1 – Year-by-year graph of global surgical volume and mortality in > 35 years of the InCor. Total Mortality rate observed (%) Number of surgeries 8 6 4 2000 3000 4000 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019-1S Quantidade de Cirurgias Tx de Mortalidade Observada 606