Key result
The EuroSCORE risk stratification model requires an update to maintain its reliability and bedside applicability for evaluating operative risk, rather than repackaging an out-of-date system.
The editorial emphasizes the need to update the EuroSCORE risk stratification model while maintaining its simplicity and bedside applicability, and highlights the importance of standardizing definitions like 'high risk'.
The November 2009 issue of the European Journal of Cardiothoracic Surgery features interesting discussions about the European System for Operative Risk Evaluation (EuroSCORE). The papers by Ranucci and colleagues [1] and Nissinen and colleagues [2] rightly highlight the limitations of EuroSCORE and suggest methods for improvement based on their institutional experiences, and they should be congratulated. More interesting, however, are the erudite accompanying editorial comments by Dewey and Herbert [3] and Nashef [4], which adequately address issues raised in the papers and the poignant editorial by Manasse [5]. There is a consensus that the EuroSCORE needs to be revised or, more appropriately, updated, and the process has been initiated. The EuroSCORE has served us well and proved to be reliable. Rather than re-package an ‘out-of-date’ system to make it appear contemporarily germane, as some of the authors have suggested, the ongoing EuroSCORE project to update the risk stratification model should be enthusiastically supported. Its main advantage, which is the simplicity and bedside applicability, should not be lost in the new form. While single institutional experiences are important to determine the performance of the risk scoring system, they cannot be reliable as the absolute measure of the precision and currency of the model, because they would be expected to ‘scatter’ about the mean. The use of confidence limits for future comparisons of single-centre mortality rates with the EuroSCORE predicted risk would be more appropriate. An important consideration for the updated EuroSCORE should be the inclusion of some definitions. Controversies about the ideal definition of ‘high risk’ should perhaps be addressed. To justify the use of alternative therapies, recent reports have variedly defined ‘high-risk’ patients using different EuroSCORE cut-offs such that some patients who would otherwise be offered conventional procedures are denied optimal surgical management because they are regarded as too high risk.
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Dumbor L. Ngaage (2010) conducted an editorial in Operative risk evaluation. EuroSCORE was evaluated. The EuroSCORE risk stratification model requires an update to maintain its reliability and bedside applicability for evaluating operative risk, rather than repackaging an out-of-date system.
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