title: Predicting in-hospital mortality after redo cardiac operations: development of a preoperative scorecard.
abstract: BACKGROUND
  The present study generated a risk model and an easy-to-use scorecard for the preoperative prediction of in-hospital mortality for patients undergoing redo cardiac operations.
  
  
  METHODS
  All patients who underwent redo cardiac operations in which the initial and subsequent procedures were performed through a median sternotomy were included. A logistic regression model was created to identify independent preoperative predictors of in-hospital mortality. The results were then used to create a scorecard predicting operative risk.
  
  
  RESULTS
  A total of 1,521 patients underwent redo procedures between 1995 and 2010 at a single institution. Coronary bypass procedures were the most common previous (58%) or planned operations (54%). The unadjusted in-hospital mortality for all redo cases was higher than for first-time procedures (9.7% vs. 3.4%; p<0.001). Independent predictors of in-hospital mortality were a composite urgency variable (odds ratio [OR], 3.47), older age (70-79 years, OR, 2.74; ≥80 years, OR, 3.32), more than 2 previous sternotomies (OR, 2.69), current procedure other than isolated coronary or valve operation (OR, 2.64), preoperative renal failure (OR, 1.89), and peripheral vascular disease (PVD) (OR, 1.55); all p<0.05. A scorecard was generated using these independent predictors, stratifying patients undergoing redo cardiac operations into 6 risk categories of in-hospital mortality ranging from <5% risk to >40%.
  
  
  CONCLUSIONS
  Reoperation represents a significant proportion of modern cardiac surgical procedures and is often associated with significantly higher mortality than first-time operations. We created an easy-to-use scorecard to assist clinicians in estimating operative mortality to ensure optimal decision making in the care of patients facing redo cardiac operations.
authors: Department of Surgery, Division of Cardiac Surgery, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
authors: Sebastian
authors: S
authors: Launcelott
authors: Maral
authors: M
authors: Ouzounian
authors: Karen J
authors: KJ
authors: Buth
authors: Jean-Francois
authors: JF
authors: Légaré
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012086:Reoperation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate