Background
Risk models play an important role in stratification of patients for cardiac surgery,
but their prognostic utilities for post-operative complications are rarely studied.
We compared the EuroSCORE, EuroSCORE II, Society of Thoracic Surgeon's (STS) Score
and an Australasian model (Aus-AVR Score) for predicting morbidities after aortic
valve replacement (AVR), and also evaluated seven STS complications models in this
context.
Methods
We retrospectively calculated risk scores for 620 consecutive patients undergoing
isolated AVR at Auckland City Hospital during 2005-2012, assessing their discrimination
and calibration for post-operative complications.
Results
Amongst mortality scores, the EuroSCORE was the best at discriminating stroke (c-statistic
0.845); the EuroSCORE II at deep sternal wound infection (c=0.748); and the STS Score
at composite morbidity or mortality (c=0.666), renal failure (c=0.634), ventilation>24 hours (c=0.732), return to theatre (c=0.577) and prolonged hospital stay >14 days
post-operatively (c=0.707). The individual STS complications models had a marginally
higher c-statistic (c=0.634-0.846) for all complications except mediastinitis, and
had good calibration (Hosmer-Lemeshow test P-value 0.123-0.915) for all complications.
Conclusion
The STS Score was best overall at discriminating post-operative complications and
their composite for AVR. All STS complications models except for deep sternal wound infection had good discrimination
and calibration for post-operative complications.
Keywords
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References
- Guidelines on the management of valvular heart disease (version 2012).Eur Heart J. 2012; 33: 2451-2496
- Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: Results from a cohort of 277 patients aged > or =80 years.Eur J Cardiothorac Surg. 2006; 30: 722-727
- PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.J Am Coll Cardiol. 2012; 60: 1438-1454
- Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement.J Thorac Cardiovasc Surg. 2008; 135: 180-187
- Society of Thoracic Surgeons score is superior to the EuroSCORE determining mortality in high risk patients undergoing isolated aortic valve replacement.Ann Thorac Surg. 2009; 88: 468-474
- Comparison of risk scores to estimate perioperative mortality in aortic valve replacement surgery.Ann Thorac Surg. 2011; 92: 535-540
- Reliability of new scores in predicting perioperative mortality after isolated aortic valve surgery: a comparison with the Society of Thoracic Surgeons score and logistic EuroSCORE.Ann Thorac Surg. 2013; 95: 1539-1544
- European system for cardiac operative risk evaluation (EuroSCORE).Eur J Cardiothorac Surg. 1999; 16: 9-13
- EuroSCORE II.Eur J Cardiothorac Surg. 2012; 41: 734-744
- Society of Thoracic Surgeons Quality Measurement Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2 - isolated valve surgery.Ann Thorac Surg. 2009; 88: S23-S42
- An Australian risk prediction model for determining early mortality following aortic valve replacement.Eur J Cardiothorac Surg. 2011; 39: 815-821
- Survival and quality of life in cardiac surgery patients with prolonged intensive care.Ann Thorac Surg. 2010; 89: 490-495
- Prediction models for prolonged intensive care unit stay after cardiac surgery: systematic review and validation study.Circulation. 2010; 122: 682-689
- Validation of EuroSCORE II in patients undergoing coronary artery bypass surgery.Ann Thorac Surg. 2012; 93: 1930-1935
- Length of intensive care unit stay following cardiac surgery: is it impossible to find a universal prediction model?.Interact Cardiovasc Thorac Surg. 2012; 15: 825-832
- Pre-operative and intraoperative determinants for prolonged ventilation following adult cardiac surgery.Acta Anaesthesiol Scand. 2012; 56: 190-199
- Does EuroSCORE predict length of stay and specific postoperative complications after coronary artery bypass grafting?.Int J Cardiol. 2005; 105: 19-25
- EuroSCORE predicts postoperative mortality, certain morbidities, and recovery time.Interact Cardiovasc Thorac Surg. 2009; 9: 613-617
- Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients.Ann Thorac Surg. 2003; 75: 472-478
- Predictors of cerebrovascular events in patients subjected to isolated coronary surgery. The importance of aortic cross-clamping.Eur J Cardiothorac Surg. 2003; 23: 328-333
- Performance of EuroSCORE II in patients who have undergone heart valve surgery: a multicentre study in a Chinese population.Eur J Cardiothorac Surg. 2014; 45: 359-364
- Predictors of acute renal failure requiring renal replacement therapy post cardiac surgery in patients with preoperatively normal renal function.Interact Cardiovasc Thorac Surg. 2007; 6: 314-318
- Requirement for renal replacement therapy in patients undergoing cardiac surgery.Thorac Cardiovasc Surg. 2004; 52: 70-76
- Clinical predictors of major infections after cardiac surgery.Circulation. 2005; 112: I358-I365
- Sternal wound infection after coronary artery bypass graft surgery: validation of existing risk scores.J Thorac Cardiovasc Surg. 2007; 133: 397-403
- Preoperative risk factors for mediastinitis after cardiac surgery: analysis of 2768 patients.Rev Bras Cir Cardiovasc. 2012; 27: 203-210
Article info
Publication history
Published online: December 11, 2014
Accepted:
November 24,
2014
Received in revised form:
August 23,
2014
Received:
March 31,
2014
Identification
Copyright
© 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
