Key result
EuroSCORE accurately predicted overall 30-day mortality (O/E ratio 0.94) but significantly overestimated mortality in very high-risk patients and was influenced by procedure type and surgeon.
Why the study?
Does the EuroSCORE accurately predict 30-day mortality in adult patients undergoing cardiovascular surgery, and is it influenced by the type of procedure and surgeon?
Observational (n=2,320)
No
Does the EuroSCORE accurately predict 30-day mortality in adult patients undergoing cardiovascular surgery, and is it influenced by the type of procedure and surgeon?
Effect estimate: O/E ratio 0.94 (95% CI 0.73-1.04)
Absolute Event Rate: 6.3% vs 6.7%
p-value: p=<0.0001
The EuroSCORE overestimates 30-day mortality in very high-risk patients and is significantly influenced by the type of procedure and the individual surgeon's performance.
EuroSCORE overestimation in high-risk cases warrants cautious use in decisions; leaves open need for procedure- and surgeon-adjusted models.
OBJECTIVE: EuroSCORE has been used in cardiac surgery operative risk assessment, despite important variables were not included. The objective of this study was to validate EuroSCORE on mortality prediction in a Brazilian cardiovascular surgery center, defining the influence of type of procedure and surgical team. METHODS: Between January 2006 and June 2011, 2320 consecutive adult patients were studied. According to additive EuroSCORE, patients were divided into low risk (score<2), medium risk (3 - 5), high risk (6 - 11) and very high risk (>12). The relation between observed mortality (O) and expected mortality (E) according to logistic EuroSCORE was calculated for each of the groups, types of procedures and surgeons with > 150 operations, and analyzed by logistic regression. RESULTS: EuroSCORE correlated to the observed mortality (O/E=0.94; P<0.0001; area under the curve 0.78). However, it overestimated the mortality in very high risk patients (O/E=0.74; P=0.001). EuroSCORE tended to overestimate isolated myocardial revascularization mortality (O/E=0.81; P=0.0001) and valve surgery mortality (O/E=0.89; P=0.007) and it tended to underestimate combined procedures mortality (O/E=1.09; P<0.0001). EuroSCORE overestimated surgeon A mortality (O/E=0.46; P<0.0001) and underestimated surgeon B mortality (O/E=1.3; P<0.0001), in every risk category. CONCLUSION: In the present population, EuroSCORE overestimates mortality in very high risk patients, being influenced by type of procedure and surgical team. The most appropriate surgical team may minimize risks imposed by preoperative profiles.
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Atik et al. (2014) conducted an observational in Cardiovascular surgery (n=2,320). EuroSCORE vs. Observed mortality was evaluated on 30-day mortality (Observed vs Expected) (O/E ratio 0.94, 95% CI 0.73-1.04, p=<0.0001). EuroSCORE accurately predicted overall 30-day mortality (O/E ratio 0.94) but significantly overestimated mortality in very high-risk patients and was influenced by procedure type and surgeon.
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