Does EuroSCORE work in individual European countries?

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Biostatistics

Background:

• National epidemiological variations in adult heart surgery across Europe raise questions about the utility of a pan-European quality assessment score.
• The EuroSCORE, a risk stratification tool, has been debated regarding its applicability across diverse European healthcare systems.

Purpose of the Study:

• To evaluate the predictive performance of the EuroSCORE within distinct national subsets of the EuroSCORE database.
• To assess the calibration and discriminative power of the EuroSCORE across different European countries.

Main Methods:

• The EuroSCORE development dataset was partitioned into national subsets, with samples exceeding 500 patients selected for analysis.
• Calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test, and discriminative power for mortality prediction was evaluated via areas under the receiver operating characteristic (ROC) curves.

Main Results:

• Analysis included 18,676 patients from six major European countries, revealing significant national differences in procedure distribution (e.g., CABG rates varied from 46.2% to 77.7%).
• The EuroSCORE demonstrated satisfactory calibration across all analyzed countries (overall P-value: 0.4).
• Areas under the ROC curve indicated good to excellent discriminative power, ranging from 0.74 (Spain) to 0.87 (Finland).

Conclusions:

• The EuroSCORE exhibits robust discriminative power in adult heart surgery across diverse European populations, performing excellently in most countries and well in Spain.
• Despite epidemiological differences, the EuroSCORE system is suitable for assessing quality improvements by surgeons and institutions.
• The score facilitates reliable international comparisons in adult cardiac surgery within Europe.