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Eur J Cardiothorac Surg 2000;18:27-30
© 2000 Elsevier Science NL
Service de Chirurgie Cardio-vasculaire, CHU de Fort de France, 97200 Fort de France, Martinique, France
Received 8 September 1999; received in revised form 21 February 2000; accepted 29 February 2000.
Corresponding author. Tel.: +596 552271; fax: +596-758438
e-mail: f.r.fwi{at}wanadoo.fr
Objective: Because of national epidemiological differences in adult heart surgery in Europe, the effectiveness and desirability of a pan-European score for the assessment of quality of surgical care remains controversial. We assessed the predictive value of EuroSCORE in national subsets of the EuroSCORE database. Methods: The EuroSCORE development data set was divided into national subsets of which those with 500 or more patients were selected for analysis. The Hosmer–Lemeshow goodness-of-fit test was applied to assess the calibration of the EuroSCORE model on individual national samples and the areas under the receiver operating characteristic (ROC) curve were measured to analyse the EuroSCORE discriminative power on individual death prediction. Results: There were 18 676 patients in the six largest national samples: Germany, United Kingdom, Spain, Finland, France and Italy (mean: 3113 patients; range: Finland 1266 to France 4507). Major differences were observed in national distribution of procedures: coronary artery bypass grafting accounted for 77.7% of procedures in Finland but only 46.2% in Spain. The EuroSCORE model goodness-of-fit was satisfactory in all countries (P-value overall: 0.4; UK: 0.34; Finland: 0.87; no values less than 0.05). Areas under ROC curves were 0.81 in Germany, 0.79 in the UK, 0.74 in Spain, 0.87 in Finland, 0.82 in France and 0.82 in Italy. Conclusion: Despite epidemiological differences between European countries, the discriminative power of EuroSCORE was good in Spain and excellent in all other countries. The system, developed from a merged European database, can therefore be used to assess improvement in quality of care achieved by surgeons and institutions as well as for international European comparison in adult heart surgery.
Key Words: Hospital mortality • Epidemiology • Open heart surgery • Europe • Risk assessment
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