Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study

Abstract

Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS. Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database; 11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less

Vasoactive-ventilation-renal score: a reliable prognostic index for perioperative outcomes following congenital heart surgery in adults

“…There has been a variable cutoff value for VVR scores in previous studies in order to predict adverse outcomes. 10,12,16,17 Miletic et al established the cutoff value of peak VVR score to be 22.5 at 48 hours in their pediatric population. 10,11 While Scherer et al reported a cutoff value of 25 for the peak VVR score at 12 hours in their population that included both children and adults with CHD, Garcia et al described a lower VIS cutoff value in an adolescent population with CHD.…”

Value of preoperative risk adjustment in congenital heart surgery (RACHS) score versus the vasoactive-ventilation-renal (VVR) score for predicting postoperative outcomes in neonates and children

“…The VVR score is a simple, cost-effective multi-organ scoring system that can be used at the bedside or for research purposes to predict patients' prognosis following cardiac surgery. The VVR score at 12 and 48 h shows the most promise and re ects postoperative outcomes, such as length of stay (LOS), intensive care unit (ICU) stay, use of mechanical ventilation, need for inotropic and vasoactive treatment, and use of dual chest tube drainage [1,3,4]. The VVR score is more accurate in predicting the severity of postoperative diseases as well as short-term outcomes, including LOS and mechanical ventilation duration, compared with single system scoring methods, such as the Vasoactive-Ionotropic Score and the peak postoperative lactate [3].…”

Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery

“…Miletic et al recently developed a new score, the vasoactive-ventilation-renal (VVR) score, to address the inability of previous scores to reflect multiorgan failure, especially concerning pulmonary and renal systems ( 11 ). The VVR score has been found to be easy to use, straightforward to calculate, and a strong predictor of postcardiac surgery outcomes ( 12 ). The VVR score was subsequently validated to predict postoperative outcomes and mortality in the pediatric postoperative cardiac surgical population ( 11 , 13 – 15 ).…”