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Is it possible to improve the accuracy of EuroSCORE?

^a Department of Thoracic and Vascular Surgery, Vaasa Central Hospital, Vaasa, Finland
^b Department of Surgery, Oulu University Hospital, Oulu, Finland
^c Department of Anesthesiology, Vaasa Central Hospital, Vaasa, Finland
^d Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland

Received 16 December 2008; received in revised form 27 March 2009; accepted 30 March 2009.

^_* Corresponding author. Address: Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland. Tel.: +358 8 315 2813/40 7333973; fax: +358 8 315 2577. (Email: fausto.biancari{at}ppshp.fi; faustobiancari{at}yahoo.it).

Objective: We derived a new risk-scoring method by modifying some of the risk factors included in the EuroSCORE algorithm. Methods: This study includes 3613 patients who underwent cardiac surgery at the Vaasa Central Hospital, Finland. The EuroSCORE variables, along with modified age classes (<60 years, 60–69.9 years, 70–79.9 years and 80 years), eGFR-based chronic kidney disease classes (classes 1–2, class 3 and classes 4–5) and the number of cardiac procedures, were entered into the regression analysis. Results: An additive risk score was calculated according to the results of logistic regression by adding the risk of the following variables: patients’ age classes (0, 2, 4 and 6 points), female (2 points), pulmonary disease (3 points), extracardiac arteriopathy (2 points), neurological dysfunction (4 points), redo surgery (3 points), critical preoperative status (8 points), left ventricular ejection fraction (>50%: 0; 30–50%: 2 and <30%: 3 points), thoracic aortic surgery (8 points), postinfarct septal rupture (9 points), chronic kidney disease classes (0, 3 and 6 points), number of procedures (1: 0; 2: 2 and 3 or more: 7 points). The modified score had a better area under the receiver operating characteristic curve (additive: 0.867; logistic: 0.873) than the EuroSCORE (additive: 0.835; logistic: 0.840) in predicting 30-day postoperative mortality. The modified score, but not EuroSCORE, correctly estimated the 30-day postoperative mortality. Conclusion: EuroSCORE still performs well in identifying high-risk patients, but significantly overestimates the immediate postoperative mortality. This study shows that the score's accuracy and clinical relevance can be significantly improved by modifying a few of its variables. This institutionally derived risk-scoring method represents a modification and simplification of the EuroSCORE and, likely, it would provide a more realistic estimation of the mortality risk after adult cardiac surgery.

Key Words: Aorta • Aortic valve • Coronary artery bypass surgery • Mitral valve • Risk • Surgery

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				S. A.M. Nashef Editorial comment: What to do with EuroSCORE in 2009? Eur. J. Cardiothorac. Surg., November 1, 2009; 36(5): 805 - 806. [Full Text] [PDF]