Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery.
BACKGROUND We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative 'additive EuroSCORE' (European system for cardiac operative risk evaluation) with the postoperative 'additive CASUS' (Cardiac Surgery Score) to form the 'modified CASUS'. MATERIAL AND METHODS We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the 'modified CASUS' were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong's method and calculated overall correct classification (OCC) values. RESULTS The mean age among the total of 5207 patients was 67.2 ± 10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6 ± 7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of 'modified CASUS': ≥ 0.929; 'additive CASUS': ≥ 0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (<0.05) in calibration. We detected the best OCC during the 2nd day (modified: 96.5%; original: 96.6%). CONCLUSIONS Our 'additive' and 'modified' CASUS are reasonable overall predictors. We could not detect any improvement in the accuracy of mortality prediction in cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended.
Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.
Fabian
F
Doerr
Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.
Matthias B
MB
Heldwein
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Germany.
Ole
O
Bayer
Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.
Anton
A
Sabashnikov
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
Alexander
A
Weymann
Department of Cardiac Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Pascal M
PM
Dohmen
Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.
Thorsten
T
Wahlers
Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.
Khosro
K
Hekmat
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D016896:Treatment Outcome