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Predicting in-hospital mortality after redo cardiac operations: development of a preoperative scorecard
Sebastian Launcelott1, Maral Ouzounian, Karen J Buth
1Department of Surgery, Division of Cardiac Surgery, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
Insights
A new scorecard helps predict in-hospital mortality for patients needing repeat cardiac surgery. This tool aids clinicians in making informed decisions for redo cardiac operations, improving patient care.
Area of Science:
- Cardiovascular Surgery
- Medical Risk Prediction
Background:
- Redo cardiac operations represent a significant portion of surgeries.
- These reoperations are associated with higher mortality rates compared to initial procedures.
Purpose of the Study:
- To develop a risk model and a user-friendly scorecard.
- To predict in-hospital mortality for patients undergoing redo cardiac operations preoperatively.
Main Methods:
- Included 1,521 patients who had redo cardiac operations via median sternotomy.
- Utilized logistic regression to identify independent preoperative mortality predictors.
- Developed a scorecard based on identified predictors to estimate operative risk.
Main Results:
- Identified key predictors: urgency, older age, multiple sternotomies, non-isolated procedures, renal failure, and peripheral vascular disease.
- The scorecard stratifies patients into 6 risk categories, from <5% to >40% in-hospital mortality.
- Unadjusted in-hospital mortality was 9.7% for redo cases versus 3.4% for first-time procedures.
Conclusions:
- Redo cardiac surgery carries a significantly higher mortality risk.
- The developed scorecard provides an accessible tool for clinicians.
- Facilitates optimal decision-making for patients undergoing repeat cardiac procedures.
Background:
The present study generated a risk model and an easy-to-use scorecard for the preoperative prediction of in-hospital mortality for patients undergoing redo cardiac operations.
Methods:
All patients who underwent redo cardiac operations in which the initial and subsequent procedures were performed through a median sternotomy were included. A logistic regression model was created to identify independent preoperative predictors of in-hospital mortality. The results were then used to create a scorecard predicting operative risk.
Results:
A total of 1,521 patients underwent redo procedures between 1995 and 2010 at a single institution. Coronary bypass procedures were the most common previous (58%) or planned operations (54%). The unadjusted in-hospital mortality for all redo cases was higher than for first-time procedures (9.7% vs. 3.4%; p<0.001). Independent predictors of in-hospital mortality were a composite urgency variable (odds ratio [OR], 3.47), older age (70-79 years, OR, 2.74; ≥80 years, OR, 3.32), more than 2 previous sternotomies (OR, 2.69), current procedure other than isolated coronary or valve operation (OR, 2.64), preoperative renal failure (OR, 1.89), and peripheral vascular disease (PVD) (OR, 1.55); all p<0.05. A scorecard was generated using these independent predictors, stratifying patients undergoing redo cardiac operations into 6 risk categories of in-hospital mortality ranging from <5% risk to >40%.
Conclusions:
Reoperation represents a significant proportion of modern cardiac surgical procedures and is often associated with significantly higher mortality than first-time operations. We created an easy-to-use scorecard to assist clinicians in estimating operative mortality to ensure optimal decision making in the care of patients facing redo cardiac operations.
