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Does EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery?
Ioannis K Toumpoulis1, Constantine E Anagnostopoulos, Daniel G Swistel
1Department of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, St Luke's-Roosevelt Hospital Center, New York, NY, USA. toumpoul@otenet.gr
Insights
The standard EuroSCORE effectively predicts cardiac surgery outcomes including mortality, prolonged hospital stay, renal failure, sepsis, and respiratory failure. This scoring system offers accurate predictions for various postoperative complications and mortality.
Area of Science:
- Cardiovascular Surgery
- Medical Informatics
- Health Services Research
Background:
- The EuroSCORE model is widely used for predicting mortality in cardiac surgery patients.
- Its performance in predicting postoperative complications and length of stay requires further evaluation.
Purpose of the Study:
- To assess the predictive accuracy of the EuroSCORE (standard and logistic) for in-hospital length of stay and major postoperative complications after cardiac surgery.
Main Methods:
- Prospective data from 5051 cardiac surgery patients were analyzed.
- EuroSCORE was used to predict in-hospital mortality, 3-month mortality, prolonged stay (>12 days), and specific complications.
- Model discrimination (C statistic) and calibration (Hosmer-Lemeshow) were evaluated.
Main Results:
- Standard EuroSCORE demonstrated good discrimination and calibration for in-hospital mortality, renal failure, sepsis/endocarditis, and respiratory failure.
- It also showed good discrimination for 3-month mortality and prolonged length of stay.
- Logistic EuroSCORE lacked calibration for most outcomes, while both versions failed to predict stroke, myocardial infarction, wound infection, gastrointestinal issues, and re-exploration for bleeding.
Conclusions:
- The standard EuroSCORE accurately predicts in-hospital mortality, 3-month mortality, prolonged length of stay, renal failure, sepsis/endocarditis, and respiratory failure in cardiac surgery.
- The standard EuroSCORE is recommended due to its simplicity and ease of calculation for predicting these outcomes.
Objective:
To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative length of stay and specific major postoperative complications after cardiac surgery.
Methods:
Data on 5051 consecutive patients (isolated [74.4%] or combined coronary artery bypass grafting [11.1%], valve surgery [12.0%] and thoracic aortic surgery [2.5%]) were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, 3-month mortality, prolonged length of stay (>12 days) and major postoperative complications (intraoperative stroke, stroke over 24 h, postoperative myocardial infarction, deep sternal wound infection, re-exploration for bleeding, sepsis and/or endocarditis, gastrointestinal complications, postoperative renal failure and respiratory failure). A C statistic (or the area under the receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer-Lemeshow goodness-of-fit statistic.
Results:
In-hospital mortality was 3.9% and 16.1% of patients had one or more major complications. Standard EuroSCORE showed very good discriminatory ability and good calibration in predicting in-hospital mortality (C statistic: 0.76, Hosmer-Lemeshow: P=0.449) and postoperative renal failure (C statistic: 0.79, Hosmer-Lemeshow: P=0.089) and good discriminatory ability in predicting sepsis and/or endocarditis (C statistic: 0.74, Hosmer-Lemeshow: P=0.653), 3-month mortality (C statistic: 0.73, Hosmer-Lemeshow: P=0.097), prolonged length of stay (C statistic: 0.71, Hosmer-Lemeshow: P=0.051) and respiratory failure (C statistic: 0.71, Hosmer-Lemeshow: P=0.714). There were no differences in terms of the discriminatory ability in predicting these outcomes between standard and logistic EuroSCORE. However, logistic EuroSCORE showed no calibration (Hosmer-Lemeshow: P<0.05) except for sepsis and/or endocarditis (Hosmer-Lemeshow: P=0.078). EuroSCORE was unable to predict other major complications such as intraoperative stroke, stroke over 24 h, postoperative myocardial infarction, deep sternal wound infection, gastrointestinal complications and re-exploration for bleeding.
Conclusions:
EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also 3-month mortality, prolonged length of stay and specific postoperative complications such as renal failure, sepsis and/or endocarditis and respiratory failure in the whole context of cardiac surgery. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation.
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