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Schilling MPR, Portela MC, Martins M. [Hospital standardized mortality ratio: limits and potential of the indicator for assessing hospital performance in the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2024; 40:e00080723. [PMID: 38422249 PMCID: PMC10896490 DOI: 10.1590/0102-311xpt080723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 03/02/2024] Open
Abstract
Comparative analyses based on clinical performance indicators to monitor the quality of hospital care have been carried out for decades in several countries, most notably the hospital standardized mortality ratio (HSMR). In Brazil, studies and the adoption of methodological tools that allow regular analysis of the performance of institutions are still scarce. This study aimed to assess the use of HSMR to compare the performance of hospitals funded by the Brazilian Unified National Health System (SUS). The Hospital Information System was the source of data on adult hospitalizations in Brazil from 2017 to 2019. The methodological approach to estimate HSMR was adapted to the available data and included the causes of hospitalization (main diagnosis) responsible for 80% of deaths. The number of expected deaths was estimated using a logistic regression model that included predictor variables widely described in the literature. The analysis was conducted in two stages: (i) hospitalization level and (ii) hospital level. The final risk adjustment model showed a C-statistic of 0.774, which is considered adequate. The variation in HSMR was wide, especially among the worst-performing hospitals (1.54 to 6.77). Private hospitals performed better than public hospitals. Although the limits of the available data and the challenges still face its more refined use, HSMR is applicable and has the potential to become an important tool for assessing hospital performance in the SUS.
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Affiliation(s)
| | | | - Mônica Martins
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Cardoso FS, Gomes DCK, Silva ASD. Racial inequality in health care of adults hospitalized with COVID-19. CAD SAUDE PUBLICA 2023; 39:e00215222. [PMID: 37971100 PMCID: PMC10645056 DOI: 10.1590/0102-311xpt215222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/02/2023] [Accepted: 07/03/2023] [Indexed: 11/19/2023] Open
Abstract
The objective was to analyze the association of race/skin color in health care, in adults hospitalized with severe acute respiratory syndrome (SARS)/COVID-19, between March 2020 and September 2022, with Brazil as the unit of analysis. This is a cross-sectional study that used the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) database and had a population composed of adults (≥ 18 years) and the final classification was SARS by COVID-19 or unspecified SARS. The direct effect of skin color on in-hospital mortality was estimated through logistic regression adjusted for age, gender, schooling level, health care system and period, stratified by vaccination status. This same model was also used to assess the effect of skin color on the variables related to access to health care services: intensive care unit (ICU), tomography, chest X-ray and ventilatory support. The results show that black, brown and indigenous people died more, regardless the schooling level and number of comorbidities, with 23%, 32% and 80% higher chances of death, respectively, when submitted to ventilatory support. Racial differences were observed in the use of health care services and in outcomes of death from COVID-19 or unspecified SARS, in which ethnic minorities had higher in-hospital mortality and lower use of hospital resources. These results suggest that black and indigenous populations have severe disadvantages compared to the white population, facing barriers to access health care services in the context of the COVID-19 pandemic.
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Costa GJ, da Silva JR, da Silva CCA, de Lima TPF, Costa MM, Sousa MHO, Costa GCDS, Costa JI, Sales MJT. Risk factors for death and illness severity in vaccinated versus unvaccinated COVID-2019 inpatients: a retrospective cohort study. J Bras Pneumol 2023; 49:e20230145. [PMID: 37729337 PMCID: PMC10578947 DOI: 10.36416/1806-3756/e20230145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/05/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To determine the clinical profile of COVID-19 inpatients who were vaccinated prior to hospitalization and to compare the risk factors for death and the 28-day survival rate of between those inpatients vaccinated with one, two, or three doses and unvaccinated COVID-19 inpatients. METHODS This was a retrospective observational cohort study involving COVID-19 patients admitted to a referral hospital in the city of Recife, Brazil, between July of 2020 and June of 2022. RESULTS The sample comprised 1,921 inpatients, 996 of whom (50.8%) were vaccinated prior to hospitalization. After adjusting the mortality risk for vaccinated patients, those undergoing invasive mechanical ventilation (IMV) had the highest mortality risk (adjusted OR [aOR] = 7.4; 95% CI, 3.8-14.1; p < 0.001), followed by patients > 80 years of age (aOR = 7.3; 95% CI, 3.4-15.4; p < 0.001), and those needing vasopressors (aOR = 5.6; 95% CI, 2.9-10.9; p < 0.001). After adjusting the mortality risk for all patients, having received three vaccine doses (aOR = 0.06; 95% CI, 0.03-0.11; p < 0.001) was the most important protective factor against death. There were progressive benefits of vaccination, reducing the frequency of ICU admissions, use for IMV, and death (respectively, from 44.9%, 39.0% and 39.9% after the first dose to 16.7%, 6.2% and 4.4% after the third dose), as well as significant improvements in survival after each subsequent dose (p < 0.001). CONCLUSIONS Vaccines were effective in reducing illness severity and death in this cohort of COVID-19 inpatients, and the administration of additional doses conferred them with accumulative vaccine protection.
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Affiliation(s)
| | - José Roberto da Silva
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
| | - Caio Cesar Arruda da Silva
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
| | | | - Mariana Menezes Costa
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
| | - Marcos Henrique Oliveira Sousa
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
| | | | - José Iran Costa
- . Departamento de Ensino e Pesquisa, Hospital Alfa, Recife (PE) Brasil
| | - Mozart Júlio Tabosa Sales
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
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Musumeci MM, Pinheiro BV, Chiavegato LD, Phillip DSA, Machado FR, Freires F, Beppu OS, Arakaki JSO, Ramos RP. Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19. J Bras Pneumol 2023; 49:e20230131. [PMID: 37729336 PMCID: PMC10578941 DOI: 10.36416/1806-3756/e20230131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify factors associated with prolonged weaning and mortality in critically ill COVID-19 patients admitted to ICUs and under invasive mechanical ventilation. METHODS Between March of 2020 and July of 2021, we retrospectively recorded clinical and ventilatory characteristics of critically ill COVID-19 patients from the day of intubation to the outcome. We classified the patients regarding the weaning period in accordance with established criteria. A logistic regression analysis was performed to identify variables associated with prolonged weaning and mortality. RESULTS The study involved 303 patients, 100 of whom (33.0%) had a prolonged weaning period. Most of the patients were male (69.6%), 136 (44.8%) had more than 50% of pulmonary involvement on chest CT, and 93 (30.6%) had severe ARDS. Within the prolonged weaning group, 62% died within 60 days. Multivariate analysis revealed that lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were significantly associated with prolonged weaning, whereas age and prolonged weaning were significantly associated with mortality. CONCLUSIONS Prolonged weaning can be used as a milestone in predicting mortality in critically ill COVID-19 patients. Lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were identified as significant predictors of prolonged weaning. These results might provide valuable information for healthcare professionals when making clinical decisions regarding the management of critically ill COVID-19 patients who are on mechanical ventilation.
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Affiliation(s)
- Marcella M Musumeci
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Bruno Valle Pinheiro
- . Disciplina de Pneumologia, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Luciana Dias Chiavegato
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Danielle Silva Almeida Phillip
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Flavia R Machado
- . Disciplina de Medicina Intensiva, Departamento de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Fabrício Freires
- . Disciplina de Medicina Intensiva, Departamento de Anestesiologia, Dor e Medicina Intensiva, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Osvaldo Shigueomi Beppu
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Jaquelina Sonoe Ota Arakaki
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Roberta Pulcheri Ramos
- . Disciplina de Pneumologia, Departamento de Medicina, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
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Chaib E, Pessoa JLE, Struchiner CJ, D'Albuquerque LAC, Massad E. THE OPTIMUM LEVEL OF MELD TO MINIMIZE THE MORTALITY ON LIVER TRANSPLANTATION WAITING LIST, AND LIVER TRANSPLANTED PATIENT IN SÃO PAULO STATE, BRAZIL. Arq Bras Cir Dig 2023; 36:e1746. [PMID: 37729279 PMCID: PMC10510095 DOI: 10.1590/0102-672020230028e1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/20/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND After validation in multiple types of liver disease patients, the MELD score was adopted as a standard by which liver transplant candidates with end-stage liver disease were prioritized for organ allocation in the United States since 2002, and in Brazil, since 2006. AIMS To analyze the mortality profile of patients on the liver transplant waiting list correlated to MELD score at the moment of transplantation. METHODS This study used the data from the Secretary of Health of the São Paulo State, Brazil, which listed 22,522 patients, from 2006 (when MELD score was introduced in Brazil) until June 2009. Patients with acute hepatic failure and tumors were included as well. We also considered the mortality of both non-transplanted and transplanted patients as a function of the MELD score at presentation. RESULTS Our model showed that the best MELD score for patients on the liver transplant waiting list associated to better results after liver transplantation was 26. CONCLUSIONS We found that the best score for applying to liver transplant waiting list in the State of São Paulo was 26. This is the score that minimizes the mortality in both non-transplanted and liver transplanted patients.
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Affiliation(s)
- Eleazar Chaib
- Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo - São Paulo (SP), Brazil
| | | | - Claudio José Struchiner
- Applied Mathematics, School of Applied Mathematics, Fundação Getulio Vargas - Rio de Janeiro (RJ), Brazil
| | | | - Eduardo Massad
- Applied Mathematics, School of Applied Mathematics, Fundação Getulio Vargas - Rio de Janeiro (RJ), Brazil
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Szor DJ, Tustumi F. The influence of institutional pancreaticoduodenectomy volume on short-term outcomes in the Brazilian public health system: 2008-2021. Rev Col Bras Cir 2023; 50:e20233569. [PMID: 37646727 PMCID: PMC10508654 DOI: 10.1590/0100-6991e-20233569-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION pancreaticoduodenectomy is a complex surgical procedure that can result in high rates of complications and morbimortality. Due to its complexity, the establishment of referral centers has increased in recent decades. This study aims to evaluate the influence of the institutional volume of pancreaticoduodenectomy for periampullary cancer on short-term outcomes in the Brazilian public health system. METHODS this study used a population-based approach and investigated the number of pancreaticoduodenectomies performed by institutions within Brazil's public health system between 2008 and 2021. High-volume institutions were defined as those that performed more than two standard deviations above the mean number of procedures per year. Specifically, if a center performed eight or more pancreaticoduodenectomies annually, it was considered a high-volume institution. RESULTS in Brazil, 283 public hospitals performed pancreaticoduodenectomy for cancer between 2008 and 2021. Only ten hospitals performed at least eight pancreaticoduodenectomies per year, accounting for approximately 3.5% of the institutions. High-volume institutions had a significantly lower in-hospital mortality rate than low-volume institutions (8 vs. 17%). No significant differences between groups were observed for length of stay, hospitalizations using the ICU, and ICU length of stay. The linear regression model showed that the number of hospital admissions for pancreaticoduodenectomy and age were significantly associated with hospital mortality. CONCLUSION institutional pancreaticoduodenectomy volume implies a lowering of in-hospital mortality. The findings of this nationwide study can affect how the public health system manages pancreaticoduodenectomy care.
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Affiliation(s)
- Daniel José Szor
- - Hospital Israelita Albert Einstein, Ciências em Saúde - São Paulo - SP - Brasil
| | - Francisco Tustumi
- - Hospital Israelita Albert Einstein, Ciências em Saúde - São Paulo - SP - Brasil
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Honorato MO, Sousa Filho JTD, Honorato Junior LFB, Watanabe N, Goulart GM, Prado RRD. Atrial Fibrillation and Sepsis in Elderly Patients and Their Associaton with In-Hospital Mortality. Arq Bras Cardiol 2023; 120:e20220295. [PMID: 36921155 PMCID: PMC9972940 DOI: 10.36660/abc.20220295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/16/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) affects about 2% to 4% of the world population, and in patients hospitalized in intensive care units, this incidence can reach up to 23% in those with septic shock. The impact of AF in patients with sepsis is reflected in worse clinical outcomes, and the identification of the triggering factors can be a target for future prevention and treatment strategies. OBJECTIVES To verify the relationship between the development of AF and mortality in patients over 80 years of age included in the sepsis protocol and to identify the risk factors that contribute to the development of AF in this population. METHODS Retrospective observational study, with a review of electronic medical records and inclusion of 895 patients aged 80 years or older, included in the sepsis protocol of a high-complexity private hospital in São Paulo, SP, from January 2018 to December 2020. All tests were performed with a significance level of 5%. RESULTS The incidence of AF in the sample was 13%. After multivariate analysis, using multiple logistic regression, it was possible to demonstrate an association of mortality, in the studied population, with the SOFA score (odds ratio [OR] 1.21 [1.09 - 1.35]), higher values of C-reactive protein (OR 1.04 [1.01 - 1.06]), need for vasoactive drugs (OR 2.4 [1.38 - 4.18]), use of mechanical ventilation (OR 3.49 [1.82 - 6.71]), and mainly AF (OR 3.7 [2.16 - 6.31]). CONCLUSION In very elderly patients (80 years of age and older) with sepsis, the development of AF was shown to be an independent risk factor for in-hospital mortality.
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Vieira RCP, Marcolino MS, Silva LGSE, Pereira DN, Nascimento BR, Jorge ADO, Ribeiro ALP. Assessment of the Impact of the Implementation of a Pre-Hospital Ambulance System on Acute Myocardial Infarction Mortality in a Developing Country. Arq Bras Cardiol 2022; 119:S0066-782X2022005016204. [PMID: 36169452 PMCID: PMC9750209 DOI: 10.36660/abc.20210953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/05/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effective management of patients with acute myocardial infarction (AMI) is time-dependent. OBJECTIVES To assess the impacts of the implementation of prehospital care on admission rates and mortality associated with AMI. METHODS Retrospective, ecological study, which assessed data from the Brazilian Universal Health System, from all 853 municipalities of Minas Gerais, from 2008 to 2016. Excessive skewness of general and in-hospital mortality rates was smoothed using the empirical Bayes method. This study assessed the relationship between Mobile Emergency Care Service (SAMU) in each municipality and the following 3 outcomes: mortality rate due to AMI, AMI in-hospital mortality, and AMI hospitalization rate, using the Poisson hierarchical model. Rates were corrected by age structure and detrended by seasonality and temporal influences. A confidence interval of 95% was adopted. RESULTS AMI mortality rates decreased throughout the study, on average 2% per year, with seasonal variation. AMI in-hospital mortality also showed a decreasing trend, from 13.81% in 2008 to 11.43% in 2016. SAMU implementation was associated with decreased AMI mortality (odds ratio [OR] = 0.967, 95% confidence interval [CI] 0.936 to 0.998) and AMI in-hospital mortality (OR = 0.914, 95% CI 0.845 to 0.986), with no relation with hospitalizations (OR = 1.003, 95% CI 0.927 to 1.083). CONCLUSION SAMU implementation was associated with a modest but significant decrease in AMI in-hospital mortality. This finding reinforces the key role of prehospital care in AMI care and the need for investments on this service to improve clinical outcomes in low- and middle-income countries.
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Affiliation(s)
- Rodrigo Costa Pereira Vieira
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Milena Soriano Marcolino
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
- Rede de Telessaúde de Minas GeraisBelo HorizonteMGBrasil Rede de Telessaúde de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Luis Gustavo Silva e Silva
- Rede de Telessaúde de Minas GeraisBelo HorizonteMGBrasil Rede de Telessaúde de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Daniella Nunes Pereira
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Bruno Ramos Nascimento
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Alzira de Oliveira Jorge
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Antonio Luiz P Ribeiro
- Faculdade de MedicinaHospital UniversitárioUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Faculdade de Medicina e Hospital Universitário , Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
- Rede de Telessaúde de Minas GeraisBelo HorizonteMGBrasil Rede de Telessaúde de Minas Gerais , Belo Horizonte , MG – Brasil
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KELLES SMB, MACHADO CJ, BARRETO SM. Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization. Arq Bras Cir Dig 2014; 27:261-7. [PMID: 25626935 PMCID: PMC4743218 DOI: 10.1590/s0102-67202014000400008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/14/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Bariatric surgery is an option for sustained weight loss for the morbidly obese patient. In Brazil coexists the Unified Health System (SUS) with universal coverage and from which depend 150 million Brazilians and supplemental health security, predominantly private, with 50 million beneficiaries. AIM To compare access, in-hospital mortality, length of stay and costs for patients undergoing bariatric surgery, assisted in one or another system. METHODS Data from DATASUS and IBGE were used for SUS patients' and database from one health plan of southeastern Brazil for the health insurance patients. RESULTS Between 2001 and 2010 there were 24,342 and 4,356 surgeries performed in SUS and in the health insurance company, respectively. The coverage rates for surgeries performed in 2010 were 5.3 and 91/100.000 individuals in SUS and health insurance respectively. The rate of in-hospital mortality in SUS, considering the entire country, was 0.55 %, 0.44 % considering SUS Southeast, and 0.30 % for the health insurance. The costs of surgery in the SUS and in the health insurance trend to equalization over the years. CONCLUSION Despite differences in access and characteristics that may compromise the outcome of bariatric surgery, patients treated at the Southeast SUS had similar rate of in-hospital mortality compared to the health insurance patients.
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Affiliation(s)
- Silvana Márcia Bruschi KELLES
- From the Faculdade de Medicina da Universidade Federal de Minas Gerais (Medical
School of the Minas Gerais Federal University), Belo Horizonte, MG, Brazil
| | - Carla Jorge MACHADO
- From the Faculdade de Medicina da Universidade Federal de Minas Gerais (Medical
School of the Minas Gerais Federal University), Belo Horizonte, MG, Brazil
| | - Sandhi Maria BARRETO
- From the Faculdade de Medicina da Universidade Federal de Minas Gerais (Medical
School of the Minas Gerais Federal University), Belo Horizonte, MG, Brazil
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Nassar Junior AP, Mocelin AO, Andrade FM, Brauer L, Giannini FP, Nunes ALB, Dias CA. SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units? SAO PAULO MED J 2013; 131:173-8. [PMID: 23903266 PMCID: PMC10852116 DOI: 10.1590/1516-3180.2013.1313474] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 02/18/2012] [Accepted: 09/20/2012] [Indexed: 12/14/2022] Open
Abstract
CONTEXT AND OBJECTIVE Acute coronary syndromes (ACS) are a common cause of intensive care unit (ICU) admission. Specific prognostic scores have been developed and validated for ACS patients and, among them, GRACE (Global Registry of Acute Coronary Events) has had the best performance. However, intensive care clinicians generally use prognostic scores developed from heterogeneous populations of critically ill patients, such as APACHE IV (Acute Physiologic and Chronic Health Evaluation IV) and SAPS 3 (Simplified Acute Physiology Score 3). The aim of this study was to evaluate and compare the performance of these three scores in a non-selected population of ACS cases. DESIGN AND SETTING Retrospective observational study to evaluate three prognostic scores in a population of ACS patients admitted to three general ICUs in private hospitals in São Paulo. METHODS All patients with ACS admitted from July 2008 to December 2009 were considered for inclusion in the study. Score calibration and discrimination were evaluated in relation to predicting hospital mortality. RESULTS A total of 1065 patients were included. The calibration was appropriate for APACHE IV and GRACE but not for SAPS 3. The discrimination was very good for all scores (area under curve of 0.862 for GRACE, 0.860 for APACHE IV and 0.804 for SAPS 3). CONCLUSIONS In this population of ACS patients admitted to ICUs, GRACE and APACHE IV were adequately calibrated, but SAPS 3 was not. All three scores had very good discrimination. GRACE and APACHE IV may be used for predicting mortality risk among ACS patients.
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Silva Junior JMD, Rezende E, Amendola CP, Tomita R, Torres D, Ferrari MT, Toledo DO, Oliveira AMRR, Marques JA. Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy. SAO PAULO MED J 2012; 130:77-83. [PMID: 22481752 PMCID: PMC10896563 DOI: 10.1590/s1516-31802012000200002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 11/12/2010] [Accepted: 07/07/2011] [Indexed: 01/31/2023] Open
Abstract
CONTEXT AND OBJECTIVE Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy. DESIGN AND SETTING Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital. METHODS All adults admitted to the ICU over a one-year period who remained there for more than 72 hours were included, except those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion, pregnant women and Jehovah's Witnesses. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl. RESULTS The study enrolled 167 patients; the acute physiology and chronic health evaluation II (APACHE II) score was 28.9 ± 6.5. The baseline hemoglobin level was 10.6 ± 2.2 g/dl and on day 28, it was 8.2 ± 1.3 g/dl (P < 0.001). Transfusions were administered to 35% of the patients. In the transfusion group, 61.1% did not survive, versus 48.6% in the non-transfusion group (P = 0.03). Transfusion was an independent risk factor for mortality (P = 0.011; odds ratio, OR = 2.67; 95% confidence interval, CI = 1.25 to 5.69). ICU stay and hospital stay were longer in the transfusion group: 20.0 (3.0-83.0) versus 8.0 (3.0-63.0) days (P < 0,001); and 24.0 (3.0-140.0) versus 14.0 (3.0-80.0) days (P = 0.002), respectively. CONCLUSIONS In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses.
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