Use of EuroSCORE as a predictor of morbidity after cardiac surgery

Abstract

ObjectiveTo evaluate the use of the EuroSCORE as a predictor of postoperative morbidity after cardiac surgery.MethodsWe retrospectively analyzed the charts of 900 patients operated on and admitted to the intensive care unit postoperatively at the Royal Portuguese Hospital of Recife. We included all patients with complete medical records, excluding those who died during surgery, underwent transplantation or correction of congenital heart disease. We evaluated the development of respiratory infection, cerebrovascular accident, and dialysis-dependent renal failure, and the EuroSCORE was compared in terms of the three complications using the Mann-Whitney test. The calibration model for predicting the morbidities being studied was evaluated using the test set of Homer-Lemeshow goodness. The accuracy of the model was assessed using the area under the ROC curve (AUROC).ResultsThe model showed good calibration in predicting respiratory infection, acute renal failure and stroke (P=0.285, P=0.789, P=0.45, respectively), with good accuracy for respiratory infection (AUROC=0.710 and P<0.001) and dialysis-dependent renal failure (AUROC=0.834 and P<0.001), but no accuracy to predict stroke (AUROC=0.519). The high-risk patients were more likely to develop respiratory infection (OR=9.05, P<0.001) and dialysis-dependent renal failure (OR=39.6, P<0.001). The probability of developing respiratory infection and dialysis-dependent renal failure was less than 10% with EuroSCORE up to 7 and more than 70% with EuroSCORE greater than 15.ConclusionEuroSCORE proved to be a good predictor of major postoperative morbidity in cardiac surgery: respiratory and dialysis-dependent renal failure.

Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score

“…According to the score, the patient is classified into groups of low (0-2), medium (3)(4)(5) and high (score greater than 6) risk of mortality in the postoperative period after cardiac surgery (15,20) .…”

“…Studies conducted with patients in the postoperative period of cardiac surgery showed that, in the first 24 hours, the nursing workload ranged from 61.6% to 96.8% (10)(11)(12)(13) . In addition, the authors observed that, in this population, the NAS was associated with adverse outcomes such as increased length of stay in the ICU, complications and mortality (13)(14)(15) . The clinical complexity of the patient's condition, highly specific care in the postoperative period, the sophistication of the treatment regimen and daily use of circulatory and respiratory support technology are elements that can directly impact nursing workload.…”

Association of Low Blood Pressure, Low Bispectral Index and Low Minimum Alveolar Concentration of Anaesthetic during Surgery with Postoperative 30-day Mortality: A Systemic Review and Meta-Analysis

“…In addition, the inclusion of patients who underwent cardiac surgery in the study by Willingham et al (12) must have had a huge influence on the results. In general, patients who underwent cardiac surgery are likely to have more underlying diseases than those who did not; furthermore, they are highly likely to be exposed to the triple low state (22 (11), respectively, were excluded from our meta-analysis. In the study by Willingham et al (12), patients who had previously undergone surgery requiring a wake-up test; those with a history of dementia, stroke and/or traumatic brain injury and those for whom consent forms could not be collected were excluded.…”

Prognostic factors influencing prolonged ventilation after open mitral valve surgery

“…The damage can manifest as postoperative stroke, impaired renal function or prolongation of ventilator use due to impaired development of less optimal pulmonary ventilation. 5 In the pulmonary hypertension data, there were three groups of subjects, namely subjects with mild pulmonary hypertension (pulmonary artery systolic pressure 25-40 mmHg), moderate (pulmonary artery systolic pressure 41-55 mmHg) and severe (pulmonary artery systolic pressure >55 mmHg). There were 22 patients included in the mild pulmonary hypertension group, in which 4 subjects (5.33%) with morbidity and 18 subjects (24%) without morbidity.…”

“…4 In addition to being a widely used predictor of mortality, EuroSCORE has proven to be a good predictor of postoperative morbidity in cardiac surgery. 5 From the prior studies by Priyatno 6 and Asmaya 7 , it was found that the most common post mitral valve surgery morbidity found in Dr. Sardjito General Hospital was postoperative prolonged ventilation, which is defined as the need of mechanical ventilation until ≥24 hours post-surgery. The need of prolonged ventilation certainly brings medical, social, and economic implications directly to the patients.…”