DAVID PROVENZALE TITINGER
Índice h a partir de 2011
3
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
2 resultados
Resultados de Busca
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- Age, Creatinine and Ejection Fraction Score in Brazil: Comparison with InsCor and the EuroSCORE(2015) MEJIA, Omar Asdrubal Vilca; MATRANGOLO, Bruna La Regina; TITINGER, David Provenzale; FARIA, Leandro Batisti de; DALLAN, Luis Roberto Palma; GALAS, Filomena Regina Barbosa; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; JATENE, Fabio BiscegliBackground: Risk scores for cardiac surgery cannot continue to be neglected. Objective: To assess the performance of ""Age, Creatinine and Ejection Fraction Score"" (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores. Methods: A prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor's and EuroSCORE's performance through correlation, calibration and discrimination tests. Results: Patients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763). Conclusion: Although simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center.
- R Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System(2015) TITINGER, David Provenzale; LISBOA, Luiz Augusto Ferreira; MATRANGOLO, Bruna La Regina; DALLAN, Luis Roberto Palma; DALLAN, Luis Alberto Oliveira; TRINDADE, Evelinda Marramon; ECKL, Ivone; KALIL FILHO, Roberto; MEJIA, Omar Asdrubal Vilca; JATENE, Fabio BiscegliBackground: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001),as well as occurrence of any postoperative complication (EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 +/- R$ 13.928,00 versus R$ 34.854,00 +/- R$ 27.814,00 versus R$ 43.234,00 +/- R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 +/- R$ 4.571,00 versus R$ 16.217,00 +/- R$ 7.298,00 versus R$ 19.548,00 +/- R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.