Risk Stratification in Off-Pump Coronary Artery Bypass (OPCAB) Surgery—Role of EuroSCORE II.
OBJECTIVE
To evaluate the EuroSCORE II for risk stratification in patients undergoing off-pump coronary artery bypass (OPCAB) surgery.


METHODS
A retrospective observational study.


METHODS
Two tertiary care hospitals.


METHODS
Participants were 1,211 patients undergoing OPCAB surgery.


METHODS
No interventions were implemented.


RESULTS
The EuroSCORE II estimated the operative risk for each patient. The calibration of the scoring system was assessed using the Hosmer Lemeshow test, and the discriminative capacity was estimated with area under receiver operating characteristic curves. The incidence, patient characteristics, causes of intraoperative conversion to on-pump coronary artery bypass (ONCAB), and outcome were studied. The all-cause in-hospital mortality was 2.39%. Predicted mortality with the EuroSCORE II was 2.03±1.63. Using the Hosmer Lemeshow test, a C statistic of 8.066 (p = 0.472) was obtained, indicating satisfactory model fit. The calculated area under the receiver operating characteristic curve was 0.706 (p = 0.0002), indicating good discriminatory power. Emergency intraoperative conversion to ONCAB occurred in 6.53% of patients. The mortality in the ONCAB group was significantly higher compared with patients who underwent successful OPCAB surgery (15.18% v 1.5%, p<0.0001). On multiple regression analysis with conversion to ONCAB as the endpoint, associated factors were patients with a higher EuroSCORE II (odds ratio = 1.13, confidence interval = 1.03-1.27) and more-than-trivial mitral regurgitation (odds ratio = 1.84, confidence interval = 1.07-3.06). Net reclassification improvement of 0.714 (p<0.0001) was obtained when on-pump conversion was added to the EuroSCORE II.


CONCLUSIONS
The EuroSCORE II has satisfactory calibration and discrimination power to predict mortality after OPCAB surgery. Intraoperative conversion to ONCAB is a major complication of OPCAB surgery. A higher EuroSCORE II also predicts higher probability of conversion to ONCAB.
Ozone Anesthesia Group. Electronic address: deepakborde2482@gmail.com.
Deepak
D
Borde
Ozone Anesthesia Group.
Balaji
B
Asegaonkar
Ozone Anesthesia Group.
Pramod
P
Apsingekar
Ozone Anesthesia Group.
Sujeet
S
Khade
Ozone Anesthesia Group.
Savani
S
Futane
Ozone Anesthesia Group.
Bapu
B
Khodve
Ozone Anesthesia Group.
Ajita
A
Annachatre
Department of Cardiac Surgery.
Manish
M
Puranik
Department of Surgery, Seth Nandlad Dhoot Hospital, Aurangabad, M.S.
Vijay
V
Borgaonkar
Department of Cardiac Surgery, M.G.M. Medical College and Hospital, Aurangabad, M.S.
Yogesh
Y
Belapurkar
Department of Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
Shreedhar
S
Joshi
D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000592:standards / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
Coronary Artery Surgery; EuroSCORE II; OPCAB; Off-Pump Surgery; Risk Stratification