Key result
EuroSCORE II underpredicts the ~9% observed early mortality in Nepalese cardiac surgeries despite good discrimination.
Why the study?
Studies validating the efficacy of EuroSCORE II are fewer in Southern Asia and lacking in Nepal.
Does EuroSCORE II accurately predict early mortality in Nepalese adults undergoing major cardiac surgeries?
Observational (n=249)
No
Does EuroSCORE II accurately predict early mortality in Nepalese adults undergoing major cardiac surgeries?
EuroSCORE II significantly underpredicts early mortality in a Nepalese cardiac surgery cohort, likely due to a younger, sicker rheumatic population, though it maintains good discriminatory capacity.
EuroSCORE II underprediction warrants caution in Nepal; leaves open recalibration for younger rheumatic cohorts.
Background and Aims: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is an important tool for risk stratification in cardiac surgery. Updated EuroSCORE II (ESC II) is widely regarded as essential for risk stratification and several studies validate its efficacy, but these are fewer in Southern Asia and none in Nepal. Aim of this study was to compare the predicted versus observed early mortality in adults undergoing major cardiac surgeries in Nepalese population. Methods: A prospective observational study was conducted from September 2019 to May 2021 at Manmohan Cardiothoracic Vascular and Transplant Center. Calibration and discrimination of scoring system were main parameters analyzed in total sample and subgroups. Discrimination were observed by plotting receiver operating characteristic (ROC) curves and calculating area under curve (AUC). Two sample t test, McNemar’s test, Fisher’s exact t test and Chi square test were used to derive P value. Results: In this study, 249 patients were evaluated. Poor mortality prediction was shown by statistically significant p value <0.05 across all surgical groups. AUC for total cases, CABG and valve surgeries were 0.835, 0.766, 0.82 respectively. Conclusion The present study underpredicted mortality but displayed good discrimination for overall cardiac surgeries, with excellent discrimination in valve surgeries. As current sample is not entirely comparable to parent study, weak calibration could be attributed to it as etiology was mostly rheumatic with poorer cardiopulmonary reserve in this study versus degenerative etiology in original study.
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Bashyal et al. (2023) conducted an observational in Major cardiac surgeries (n=249). EuroSCORE II vs. Observed mortality was evaluated on Early mortality (predicted vs observed) (AUC 0.835, p=<0.001). EuroSCORE II significantly underpredicted early mortality (1.98% vs 8.8% observed, p<0.001) but showed good discrimination (AUC 0.835) for cardiac surgeries in Nepal.
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