open access

Vol 22, No 5 (2015)
Original articles
Published online: 2015-10-27
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Mortality in low- and very low-risk patients undergoing cardiac surgery: Evaluation according to the EuroSCORE II as a new standard

Raul Alfredo Borracci, Miguel Rubio, Julio Baldi Jr, Rodolfo A. Ahuad Guerrero, Víctor Mauro
DOI: 10.5603/CJ.a2015.0028
·
Pubmed: 26004937
·
Cardiol J 2015;22(5):495-500.

open access

Vol 22, No 5 (2015)
Original articles
Published online: 2015-10-27

Abstract

Background: Only a few reports have analyzed low-risk patient outcomes and in every case, the risk was based on a logistic EuroSCORE ≤ 2. Since this original EuroSCORE overestimates surgical risk, we developed this study to prospectively evaluate the immediate results of cardiac surgery in patients with an expected mortality risk ≤ 2% according to the EuroSCORE II as a new gold standard. We also examined the cause of death and whether it could be considered preventable.

Methods: A prospective risk stratification of all cardiac surgical patients treated at the Bue­nos Aires University Hospital of Argentina was performed between 2012 and 2014 using the EuroSCORE II. Causes of death were classified as preventable or not preventable.

Results: From a total of 990 patients, 63.2% had EuroSCORE II ≤ 2 (low-risk group) and 32.5% EuroSCORE II < 1 (very low-risk group). In the low-risk group, in-hospital mortal­ity was 1.8%, whereas predicted mortality was 1.04% (AUC 0.765). The observed/expected ratio was 1.73 (95% CI 0.68–4.43) and the observed-expected difference was 0.76 (95% CI –0.68–2.10). Fifty-four percent of deaths were considered preventable.

Conclusions: We propose to use and further validate the EuroSCORE II as a new standard for assessing low-risk patients. This model proved to be useful in evaluating the quality standards of local cardiac surgery. The review of cause of death in low-risk patients provided valuable information, which revealed potentially correctable issues. Adoption of a more demanding standard, as the EuroSCORE II to identify low-risk patients, avoids the sense of safety offered by previous versions of the score.

Abstract

Background: Only a few reports have analyzed low-risk patient outcomes and in every case, the risk was based on a logistic EuroSCORE ≤ 2. Since this original EuroSCORE overestimates surgical risk, we developed this study to prospectively evaluate the immediate results of cardiac surgery in patients with an expected mortality risk ≤ 2% according to the EuroSCORE II as a new gold standard. We also examined the cause of death and whether it could be considered preventable.

Methods: A prospective risk stratification of all cardiac surgical patients treated at the Bue­nos Aires University Hospital of Argentina was performed between 2012 and 2014 using the EuroSCORE II. Causes of death were classified as preventable or not preventable.

Results: From a total of 990 patients, 63.2% had EuroSCORE II ≤ 2 (low-risk group) and 32.5% EuroSCORE II < 1 (very low-risk group). In the low-risk group, in-hospital mortal­ity was 1.8%, whereas predicted mortality was 1.04% (AUC 0.765). The observed/expected ratio was 1.73 (95% CI 0.68–4.43) and the observed-expected difference was 0.76 (95% CI –0.68–2.10). Fifty-four percent of deaths were considered preventable.

Conclusions: We propose to use and further validate the EuroSCORE II as a new standard for assessing low-risk patients. This model proved to be useful in evaluating the quality standards of local cardiac surgery. The review of cause of death in low-risk patients provided valuable information, which revealed potentially correctable issues. Adoption of a more demanding standard, as the EuroSCORE II to identify low-risk patients, avoids the sense of safety offered by previous versions of the score.

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Keywords

risk analysis, perioperative care, surgical complications, EuroSCORE II

About this article
Title

Mortality in low- and very low-risk patients undergoing cardiac surgery: Evaluation according to the EuroSCORE II as a new standard

Journal

Cardiology Journal

Issue

Vol 22, No 5 (2015)

Pages

495-500

Published online

2015-10-27

DOI

10.5603/CJ.a2015.0028

Pubmed

26004937

Bibliographic record

Cardiol J 2015;22(5):495-500.

Keywords

risk analysis
perioperative care
surgical complications
EuroSCORE II

Authors

Raul Alfredo Borracci
Miguel Rubio
Julio Baldi Jr
Rodolfo A. Ahuad Guerrero
Víctor Mauro

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