Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample

Zingone, Bartolo

doi:10.1016/j.ejcts.2004.09.003

Cited by 55 publications

(30 citation statements)

References 20 publications

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“…17 From the Society of Thoracic Surgeons national database, it emerged that emergent/salvage presentation, preoperative intra-aortic balloon pump, renal failure, peripheral vascular disease, and cerebrovascular disease are predictors of operative mortality. 18 Small series are in agreement with the finding that nonelective presentation is associated with poor results, and our findings corroborate this concept. If properly selected and operated on earlier and electively, nonagenarians may face cardiac operations at a risk approaching that of younger candidates, namely, octogenarians.…”

Section: Discussionsupporting

confidence: 82%

Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

Saglio¹,

Nasso²,

Barattoni³

et al. 2010

Circulation

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Background-Age Ͼ90 years represents in many centers an absolute contraindication to cardiac surgery. Nonagenarians are a rapidly growing subset of the population posing an expanding clinical problem. To provide helpful information in regard to this complex decision, we analyzed the operative and 5-year results of coronary and valvular surgical procedures in these patients. Methods and Results-We retrospectively reviewed 127 patients aged Ն90 years who underwent cardiac surgery within our hospital group in the period 1998 to 2008. Kaplan-Meier and multiple logistic regression analyses were performed. A longer follow-up than most published studies and the largest series published thus far are presented. Mean age was 92 years (range, 90 to 103 years). Mean logistic EuroSCORE was 21.3Ϯ6.1. Sixty patients had valvular surgery (including 11 valve repairs), 49 patients had coronary artery bypass grafting, and 18 had valvular plus coronary artery bypass grafting surgery (55 left mammary artery grafts implanted). Forty-five patients (35.4%) were operated on nonelectively. Operative mortality was 13.4% (17 cases). Fifty-four patients (42.5%) had a complicated postoperative course. There were no statistically significant differences in the rate and type of complications between patient strata on the basis of type of surgery performed. Nonelective priority predicted a complicated postoperative course. Predictors of operative mortality were nonelective priority and previous myocardial infarction. Kaplan-Meier survival estimates at 5 years were comparable between patient groups on the basis of procedure performed. Conclusions-Although the rate of postoperative complications remains high, cardiac surgery in nonagenarians can achieve functional improvement at the price of considerable operative and follow-up mortality rates. Cardiac operations in these very elderly subjects are supported if appropriate selection is made and if the operation is performed earlier and electively. Our results should contribute to the development of guidelines for cardiac operations in nonagenarians.

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Section: Discussionsupporting

confidence: 82%

Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

Saglio¹,

Nasso²,

Barattoni³

et al. 2010

Circulation

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“…Sensitivity analysis excluding this centre did not differ from the analysis including it. The proportion of patients lying above the risk level where the additive EuroSCORE starts to underperform (EuroSCORE ≥ 10%) was very small (0.62%, n = 689 of 110 769) 14, 20. All centres were high‐volume, with only two having fewer than 800 cases per year, the largest high‐volume threshold encountered in the literature 21.…”

Section: Resultsmentioning

confidence: 99%

The contribution of the anaesthetist to risk‐adjusted mortality after cardiac surgery

et al. 2015

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SummaryIt is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix‐adjusted outcomes were analysed in models that included random‐effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in‐hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in‐hospital mortality. The impact of the surgeon was moderate (intra‐class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity.

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“…The discriminatory power of the model for those who survived or evolved to death was assessed by the area under the ROC curve of 0.79, a satisfactory level. Logistic model was used because it showed the highest reliability in predicting the death when prospectively applied in 24 026 patients operated between January 1999 and April 2004 [23].…”

Section: Discussionmentioning

confidence: 99%

Aplicação do EuroSCORE na cirurgia de revascularização miocárdica em hospitais públicos do Rio de Janeiro

Carvalho¹,

Silva²,

Klein³

et al. 2010

Rev Bras Cir Cardiovasc

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Background: Risk stratification models are used to assess the risk of death in surgery.Objective: To conduct a critical analysis of the EuroSCORE logistic model (ES) application in 2,692 patients undergoing Coronary Artery Bypass Grafting (CABG) in four public hospitals in the Rio de Janeiro Municipality, from 1999 through to December 2003.Methods: Random samples of 150 medical records for surviving and deceased patients were selected at four public hospitals in the City of Rio de Janeiro. The ES was applied, using the logistical model. The observed lethality rate and that forecast by the model were compared. The measurement of the discriminatory power was estimated by the area under the ROC curve.Results: 546 of the 600 selected medical records were located. A significant difference was noted between the prevalence rates for the risk factors in the Brazilian and European populations. The forecast lethality rate was 3.62% (CI-95%: 3.47-3.78) while the estimated observed rate was 12.22% (CI-95%-10.99-13.46). In all risk ranges, the predicted lethality rate is under-estimated, with notable differences between the predicted and observed rates. The area under the ROC curve was estimated at 0.62. Conclusion: The differences in the prevalence rates for the risk factors constituting the ES, associated with its low power of discrimination, hamper any recommendation of the use of this model in Brazil, without the necessary adjustments.Descriptors: Risk Factors; Coronary Artery Bypass; Coronary Artery Disease. 210CARVALHO, MRM ET AL -Application of the EuroSCORE in coronary artery bypass surgery in public hospitals in Rio de Janeiro, Brazil Rev Bras Cir Cardiovasc 2010; 25(2): 209-217

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Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample

Cited by 55 publications

References 20 publications

Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

The contribution of the anaesthetist to risk‐adjusted mortality after cardiac surgery

Aplicação do EuroSCORE na cirurgia de revascularização miocárdica em hospitais públicos do Rio de Janeiro

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