Risk prediction in coronary artery surgery: a comparison of four risk scores

Abstract

Objective To determine which of four proposed risk scores best predicts immediate outcome of cardiac surgery. Design Observational cohort study. Setting Sir Charles Gairdner Hospital (a university teaching hospital), Perth, Western Australia, 18 March 1993 to 5 March 1996. Subjects 927 consecutive patients undergoing surgery for coronary artery disease. Outcome measures Patient risk scores (by methods of Parsonnet et al., Higgins et al., Tremblay et al. and Tu et al.); in‐hospital mortality; postoperative hospital stay >14 days; receiver operating characteristic (ROC) curves comparing sensitivity and specificity in predicting adverse outcomes for each risk score. Results In‐hospital mortality rate was 3.5% and mean postoperative hospital stay was 10.7 days. The four scores had similar predictive abilities, with mean areas under the ROC curves (95% confidence intervals) for mortality and postoperative stay >14 days, respectively: 0.70 (0.62‐0.78) and 0.70 (0.65‐0.75) for the Parsonnet score; 0.68 (0.59‐0.77) and 0.70 (0.64‐0.75) for the Higgins score; 0.68 (0.59‐0.77) and 0.67 (0.62‐0.73) for the Tremblay score; and 0.68 (0.60‐0.76) and 0.69 (0.64‐0.75) for the Tu score. Conclusion Any of the scores may be used to estimate perioperative risk and to compare outcome between coronary surgery units, but none has sufficient specificity and sensitivity to identify specific individuals who will experience an adverse outcome. Further development of risk assessment is needed before adverse outcome can be accurately predicted in cardiac surgical patients.

Comparative analysis of risk-adjusted bypass surgery stratification models in a community hospital

“…The NY C-statistics range from 0.72 15,16 to 0.787 4 and the CA C-statistics range from 0.60 to 0.755. 3,[9][10][11]15,16,32,33 These mortality models may be used to conduct comparisons of risk-adjusted cardiac surgical outcomes among adult cardiac surgical institutions. Hospitals may determine their risk-adjusted outcomes so they can evaluate their relative performance with the goal of continuous quality improvement and allow clinicians to see how well they are performing relative to others at different levels of patient risk, and provides a summary measure of a hospital's case mix severity.…”

“…2 The CA model has also been tested in a variety of settings with samples ranging from 505 to 7491. 9,10,14 For this study, isolated CABG outcomes, 1 variable (type of surgery) was set to its null value, leaving only 5 variables and their associated risk scores.…”

“…1 The PA model has been examined worldwide in a variety of settings with samples ranging from 465 to 3443. [9][10][11][12][13] We used a current version of the PA mortality model, the St. George's Hospital PA calculator (Table I). 13 The CA score was developed from the Ontario Ministry of Health Provincial Adult Cardiac Care Network computerized registry.…”

Predictive Value of EuroSCORE and Parsonnet Scoring in Saudi Population

“…1 However, they are generally quite complicated for practical use, often requiring detailed data that may not be available in all the patients. 2 There are also significant differences with regards to score design and initial patient population on which score development was based.…”

Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery

“…A variety of multifactorial risk indexes have been described to help delineate preoperative risk assessment of patients undergoing cardiac surgery (1)(2)(3)(4)(5). However, their ability to effectively predict postoperative complications, hospital stay, and mortality is uncertain, and no gold standard currently exists (6,7). Furthermore, many of these assessment tools are not routinely utilized in preoperative evaluation because of complexity, inaccuracy when applied to individuals, unavailability of important variables, and/or time constraints (6,8,9).…”