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Eur J Cardiothorac Surg 2005;27:128-133
© 2005 Elsevier Science NL
a Department of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, St Luke's-Roosevelt Hospital Center, New York, NY, USA
b Department of Cardiac Surgery, University of Athens School of Medicine, Attikon Hospital Center, Athens, Greece
Received 24 June 2004; received in revised form 22 September 2004; accepted 24 September 2004.
* Corresponding author. Address: Department of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, St Luke's-Roosevelt Hospital Center, 515 West 59th Street, New York, NY, USA. Tel.: +1 30 697 724 3942; fax: +1 646 365 6006. (E-mail: toumpoul{at}otenet.gr).
Objective: To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative length of stay and specific major postoperative complications after cardiac surgery. Methods: Data on 5051 consecutive patients (isolated [74.4%] or combined coronary artery bypass grafting [11.1%], valve surgery [12.0%] and thoracic aortic surgery [2.5%]) were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, 3-month mortality, prolonged length of stay (>12 days) and major postoperative complications (intraoperative stroke, stroke over 24h, postoperative myocardial infarction, deep sternal wound infection, re-exploration for bleeding, sepsis and/or endocarditis, gastrointestinal complications, postoperative renal failure and respiratory failure). A C statistic (or the area under the receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer–Lemeshow goodness-of-fit statistic. Results: In-hospital mortality was 3.9% and 16.1% of patients had one or more major complications. Standard EuroSCORE showed very good discriminatory ability and good calibration in predicting in-hospital mortality (C statistic: 0.76, Hosmer–Lemeshow: P=0.449) and postoperative renal failure (C statistic: 0.79, Hosmer–Lemeshow: P=0.089) and good discriminatory ability in predicting sepsis and/or endocarditis (C statistic: 0.74, Hosmer–Lemeshow: P=0.653), 3-month mortality (C statistic: 0.73, Hosmer–Lemeshow: P=0.097), prolonged length of stay (C statistic: 0.71, Hosmer–Lemeshow: P=0.051) and respiratory failure (C statistic: 0.71, Hosmer–Lemeshow: P=0.714). There were no differences in terms of the discriminatory ability in predicting these outcomes between standard and logistic EuroSCORE. However, logistic EuroSCORE showed no calibration (Hosmer–Lemeshow: P<0.05) except for sepsis and/or endocarditis (Hosmer–Lemeshow: P=0.078). EuroSCORE was unable to predict other major complications such as intraoperative stroke, stroke over 24h, postoperative myocardial infarction, deep sternal wound infection, gastrointestinal complications and re-exploration for bleeding. Conclusions: EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also 3-month mortality, prolonged length of stay and specific postoperative complications such as renal failure, sepsis and/or endocarditis and respiratory failure in the whole context of cardiac surgery. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation.
Key Words: Cardiac surgery • EuroSCORE • Length of stay • Postoperative complications
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