Supplementing prediction by EuroSCORE with social and patient reported measures among patients undergoing cardiac surgery

Objectives The risk of poor outcomes is traditionally attributed to biological and physiological processes in cardiac surgery. However, evidence exists that other factors, such as emotional, behavioural, social and functional, are predictive of poor outcomes. Objectives were to evaluate the predictive value of several emotional, social, functional and behavioural factors on four outcomes; death within 90 days, prolonged stay in intensive care, prolonged hospital admission and readmission within 90 days following cardiac surgery. Methods This prospective study included adults undergoing cardiac surgery 2013-2014, including information on register-based socio-economic factors and self-reported health in a nested subsample. Logistic regression analyses to determine the association and incremental value of each candidate predictor variable were conducted. Multiple regression analyses were used to determine the incremental value of each candidate predictor variable, as well as discrimination and calibration based on AUC and Brier score. Results Of 3217 patients, 3% died, 9% had prolonged intensive care stay, 51% had prolonged hospital admission and 39% were readmitted to hospital. Patients living alone (OR, 1.19; 95% CI, 1.02-1.38), with lower educational levels (1.27; 1.04-1.54) and low health-related quality of life (1.43; 1.02-2.01) had prolonged hospital admission. Analyses revealed living alone as predictive of prolonged ICU stay (Brier, 0.08; AUC, 0.68), death (0.03; 0.71) and prolonged hospital admission (0.24; 0.62). Conclusion Living alone was found to supplement EuroSCORE in predicting death, prolonged hospital admission and prolonged ICU stay following cardiac surgery. Low educational level and impaired health-related quality of life were, furthermore, predictive of prolonged hospital admission.