Practical use of a risk assessment model for complications after cardiac surgery.
BACKGROUND
The identification of risk factors for postoperative complications in cardiac patients with surgical indication may influence the therapeutic decision.


OBJECTIVE
To describe the experience of a Cardiology hospital in the validation and practical use of a preoperative risk score.


METHODS
To validate TUMAN's score, chosen by considering morbidity and mortality, 300 adult patients were prospectively evaluated before elective cardiac surgery with the use of extracorporeal circulation (ECC). Patients with a score of zero to five were considered as being low risk; from six to nine, as moderate risk and a score higher than 10 as high risk for cardiac, infectious, neurological, pulmonary and renal complications, as well as death.


RESULTS
The TUMAN classification showed a statistically significant association with the occurrence of infectious complications (p = 0.010), with the other postoperative complications (p = 0.034) and death (p <0.001). Pulmonary infection was the most frequent infectious complication (15.3%) and Infected patients had a longer ICU stay duration (p = 0.001) and more prolonged hospitalization (p = 0001). After routine use, a new review of 154 patients operated in 2005, confirmed the validity of this score in the identification of those with the highest risk of postoperative infections.


CONCLUSIONS
TUMAN's score was chosen as it uses variables that can be promptly obtained, classifies in the same system the most frequently performed surgeries and predicts risk of postoperative complications, in addition to mortality. Its continued use in this hospital has been able to identify the group of patients with increased risk of complications, especially infectious ones, although it was not useful in the prediction of individual risk.
Strabelli
Tânia Mara Varejão
TM
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. tania.strabelli@incor.usp.br
Stolf
Noedir Antonio Groppo
NA
Uip
David Everson
DE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011300:Preoperative Care; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology; D018570:Risk Assessment / Q000592:standards; D012307:Risk Factors; D055815:Young Adult