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Predictive Performance of POSPOM and EuroSCORE-II for Perioperative Mortality in Cardiac Surgery: A Retrospective
1Department of Anesthesiology and Reanimation, Institute of Cardiology, Istanbul University, Cerrahpasa, İstanbul, Turkiye.
Background:
Simpler generalized scores such as POSPOM (PreOperative Score to Predict Post-Operative Mortality) may appear attractive because they can be derived from routinely available variables and applied across surgical specialties, although their reliability in cardiac surgery remains uncertain.
Aim:
To compare the performance of POSPOM and EuroSCORE-II scores for predicting in-hospital mortality among patients undergoing cardiac surgery.
Methods:
This retrospective observational cohort study was conducted at a single tertiary university cardiac surgery center. A total of 320 adult patients (≥18 years) who underwent coronary artery bypass grafting, valve surgery, or combined procedures between 2021 and 2024 were included. Discrimination was assessed using ROC and precision-recall curves with DeLong's test. Calibration was evaluated using calibration-in-the-large, calibration slope, Hosmer-Lemeshow testing, and GiViTI calibration belts. Agreement was analyzed using intraclass correlation coefficient (ICC), Concordance Correlation Coefficient (CCC), Bland- Altman plots, and Passing-Bablok and Deming regression.
Results:
In-hospital mortality was 7.5% (24/320). POSPOM showed poorer discrimination than EuroSCORE-II (AUC 0.611 vs. 0.745; P = 0.012) and lower PR-AUC (0.115 vs. 0.287). Both models showed imperfect calibration, and agreement between scores was weak (ICC 0.283), with systematic differences observed between predicted mortality estimates. Exploratory segmented regression suggested that inter-model divergence increased with age, with an estimated breakpoint near 59 years. POSPOM did not improve reclassification (continuous NRI -0.31), and decision curve analysis favored EuroSCORE-II.
Conclusion:
POSPOM showed poorer predictive performance than EuroSCORE-II for in-hospital mortality after cardiac surgery. However, these findings should be interpreted cautiously in light of the limited number of mortality events, retrospective reconstruction of POSPOM, and the need for external validation.
