Does EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery?
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.
Toumpoulis
Ioannis K
IK
Department of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, St Luke's-Roosevelt Hospital Center, New York, NY, USA. toumpoul@otenet.gr
Anagnostopoulos
Constantine E
CE
Swistel
Daniel G
DG
DeRose
Joseph J
JJ
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods; D004696:Endocarditis / Q000175:diagnosis; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011446:Prospective Studies; D012372:ROC Curve; D051437:Renal Insufficiency / Q000175:diagnosis; D012131:Respiratory Insufficiency / Q000175:diagnosis; D018570:Risk Assessment / Q000379:methods; D018805:Sepsis / Q000175:diagnosis