Outcome Prediction After Coronary Surgery and Redo Surgery for Bleeding (From the KROK Registry)

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Biostatistics

Background:

• The EuroSCORE II is a tool for predicting mortality in cardiac surgery patients.
• Its reliability in specific surgical populations, particularly those requiring reoperation, requires validation.
• Bleeding is a common indication for reoperation after cardiac surgery, associated with increased mortality risk.

Purpose of the Study:

• To evaluate the predictive accuracy of EuroSCORE II for isolated coronary artery surgery.
• To assess EuroSCORE II's reliability in patients undergoing redo surgery for bleeding.
• To develop an improved model for predicting hospital mortality in patients requiring redo surgery due to bleeding.

Main Methods:

• Retrospective analysis of 41,353 patients from the Polish National Registry of Cardiac Surgical Procedures (2012-2014).
• Evaluation of EuroSCORE II performance using Area Under the Receiver Operating Characteristics Curve (AUC) and Observed-to-Expected (O/E) mortality ratio.
• Development of a calibration model for EuroSCORE II in the reoperation subgroup.

Main Results:

• EuroSCORE II demonstrated good reliability for the overall cohort (AUC 0.76, O/E 1.08).
• The score significantly underestimated mortality in the reoperation subgroup (AUC 0.74, O/E 4.33), especially in lower-risk patients.
• An adjusted EuroSCORE II model with a calibration coefficient and nomogram improved prediction accuracy for redo surgery patients.

Conclusions:

• EuroSCORE II is reliable for isolated coronary artery surgery in the Polish population.
• Observed mortality is substantially higher in patients undergoing redo surgery for bleeding compared to the general coronary surgery population.
• A modified EuroSCORE II, incorporating a calibration coefficient, enhances mortality prediction accuracy for patients requiring reoperation due to bleeding.