The first Latin-American risk stratification system for cardiac surgery: can be used as a graphic pocket-card score

Abstract

This study aims to develop the first Latin-American risk model that can be used as a simple, pocket-card graphic score at bedside. The risk model was developed on 2903 patients who underwent cardiac surgery at the Spanish Hospital of Buenos Aires, Argentina, between June 1994 and December 1999. Internal validation was performed on 708 patients between January 2000 and June 2001 at the same center. External validation was performed on 1087 patients between February 2000 and January 2007 at three other centers in Argentina. In the development dataset the area under receiver operating characteristics (ROC) curve was 0.73 and the Hosmer-Lemeshow (HL) test was P=0.88. In the internal validation ROC curve was 0.77. In the external validation ROC curve was 0.81, but imperfect calibration was detected because the observed in-hospital mortality (3.96%) was significantly lower than the development dataset (8.20%) (P<0.0001). Recalibration was done in 2007, showing excellent level of agreement between the observed and predicted mortality rates on all patients (P=0.92). This is the first risk model for cardiac surgery developed in a population of Latin-America with both internal and external validation. A simple graphic pocket-card score allows an easy bedside application with acceptable statistic precision.

Ventilación mecánica prolongada en sujetos posquirúrgicos cardiovasculares

“…En el período preoperatorio se registraron los datos demográficos, antecedentes y se calcularon el índice de comorbilidad de Charlson (ICC) 15 y el ArgenSCO-RE. 16 Se realizó una intervención prequirúrgica a cargo de un kinesiólogo que consistió en brindar pautas con respecto al cuidado de la esternotomía mediana, técnicas tusígenas y movilización precoz posoperatoria (POP). 17,18 Una vez finalizada la CCV el sujeto se trasladaba a la sala de RCV o a la Unidad Coronaria.…”

A Novel Risk Stratification System for Predicting In-Hospital Mortality Following Coronary Artery Bypass Grafting Surgery with Impaired Left Ventricular Ejection Fraction

“…However, the use of in-hospital death as the endpoint is justified by the following reasons. First, other studies also used in-hospital mortality [Hannan 2006;Carosella 2009]. Second, the length of postoperative hospital stay is much longer in China than the US and Europe: the mean postoperative length of stay (PLOS) in our study population was 13.5 days, whereas a study that utilized data (496 797 procedures from 1997 to 2001) from the STS database had a mean PLOS of 6.9 days [Peterson 2002].…”

EuroSCORE subestima el riesgo de mortalidad en cirugía cardiaca valvular de población mexicana

“…Es atractiva la idea de validar scores específicos de cirugía valvular, como el de New York 27 , que tiene un índice para cirugía valvular aislada y otro para pacientes con RVC, con el inconveniente de que no lo hace de manera automática. Por otra parte, Argentina publicó el primer sistema latinoamericano para estratificar el riesgo en cirugía cardiaca desarrollado en su población 40 , y aunque nuestras características demográficas podrían ser diferentes, creemos que valdría la pena validarlo también en nuestro hospital.…”