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Does EuroSCORE work in individual European countries?

F Roques1, S A Nashef, P Michel

  • 1Service de Chirurgie Cardio-vasculaire, CHU de Fort de France, 97200 Fort de France, Martinique, France. f.r.fwi@wanadoo.fr

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|June 28, 2000
PubMed
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The EuroSCORE effectively predicts adult heart surgery outcomes across European nations, demonstrating good to excellent discriminative power. This validates its use for quality assessment and international comparisons despite varied surgical practices.

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.

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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.