Περίληψη:
Objective: To evaluate the performance of EuroSCORE in the prediction of
in-hospital postoperative length of stay and specific major
postoperative complications after cardiac surgery. Methods: Data on 5051
consecutive patients (isolated [74.4%] or combined coronary artery
bypass grafting [11.1%], valve surgery [12.0%] and thoracic aortic
surgery [2.5%]) were prospectively collected. The EuroSCORE model
(standard and logistic) was used to predict in-hospital mortality,
3-month mortality, prolonged length of stay (> 12 days) and major
postoperative complications (intraoperative stroke, stroke over 24 h,
postoperative myocardial infarction, deep sternal wound infection,
re-exploration for bleeding, sepsis and/or endocarditis,
gastrointestinal complications, postoperative renal failure and
respiratory failure). A C statistic (or the area under the receiver
operating characteristic curve) was used to test the discrimination of
the EuroSCORE. The calibration of the model was assessed by the
Hosmer-Lemeshow goodness-of-fit statistic. Results: In-hospital
mortality was 3.9% and 16.1% of patients had one or more major
complications. Standard EuroSCORE showed very good discriminatory
ability and good calibration in predicting in-hospital mortality (C
statistic: 0.76, Hosmer-Lemeshow: P = 0.449) and postoperative renal
failure (C statistic: 0.79, Hosmer-Lemeshow: P = 0.089) and good
discriminatory ability in predicting sepsis and/or endocarditis (C
statistic: 0.74, Hosmer-Lemeshow: P = 0.653), 3-month mortality (C
statistic: 0.73, Hosmer-Lemeshow: P = 0.097), prolonged length of stay
(C statistic: 0.71, Hosmer-Lemeshow: P = 0.051) and respiratory failure
(C statistic: 0.71, Hosmer-Lemeshow: P = 0.714). There were no
differences in terms of the discriminatory ability in predicting these
outcomes between standard and logistic EuroSCORE. However, Logistic
EuroSCORE showed no calibration (Hosmer-Lemeshow: P < 0.05) except for
sepsis and/or endocarditis (Hosmer-Lemeshow: P = 0.078). EuroSCORE was
unable to predict other major complications such as intraoperative
stroke, stroke over 24 h, postoperative myocardial infarction, deep
sternal wound infection, gastrointestinal complications and
re-exploration for bleeding. Conclusions: EuroSCORE can be used to
predict not only in-hospital mortality, for which it was originally
designed, but also 3-month mortality, prolonged length of stay and
specific postoperative complications such as renal failure, sepsis
and/or endocarditis and respiratory failure in the whole context of
cardiac surgery. These outcomes can be predicted accurately using the
standard EuroSCORE which is very simple and easy in its calculation. (C)
2004 Elsevier B.V. All rights reserved.
Συγγραφείς:
Toumpoulis, IK
Anagnostopoulos, CE
Swistel, DG
DeRose, JJ
