a cirugía cardiaca en el Hospital Regional de Alta Especialidad del Bajío To validate the EuroSCORE model in adult patients at the Hospital. Assessment of Euroscore and SAPS III as hospital mortality (1)Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen. According to the EuroSCORE, 55 patients were classified as high risk (%), .. de Disfunción Renal en Cirugía Cardiaca) Cardiac-surgery associated acute .
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Risk of operative mortality is one of the factors considered by the clinical cardiologist when weighing the indication for surgery of a specific patient.
Traditionally, the magnitude of this risk has been estimated in an intuitive, and therefore ciruia, manner. In recent years, the application of multivariate analysis in large surgical series has made it possible to obtain independent mortality predictors and use them to create scales for preoperative estimation of the risk of heart surgery.
The use of these scales provides the surgeon with greater latitude when deciding whether surgery is indicated, as it allows the risk related to the natural history of the disorder to be weighed against the risk of surgery.
Furthermore, risk assessment scales are becoming basic instruments for measuring the quality of surgical activity.
Validation of the EuroSCORE Probabilistic Model in Patients Undergoing Coronary Bypass Grafting
The scales can be used to estimate any deviation between actual and theoretical or expected mortality, based on the risk of the population studied.
The degree and type of cirugi can then be used to compare surgery in various countries 4 or departments, or within the same department over different periods. A minimum value cirugoa the absence of risk variables, and therefore should correspond to minimum mortality. The purposes of our study were: We only analyzed patients undergoing isolated on- or off-pump coronary artery bypass grafting CABG or valve cirufia or repair surgery VSwhich accounted for During the study periodoperations were performed A total of operations were performed in ; The EuroSCORE Appendix 1 was prospectively calculated at the time of admission when the patient had been referred for surgical treatment by his or her cardiologist in the usual manner; i.
The minimum score indicates that there are no cirugiia variables, except those pertaining to gender and the type of surgery Appendix 1. In all patients, we analyzed the total in-hospital mortality, defined as death occurring before hospital discharge. The discrete variables are expressed as a percentage.
For the analysis of quantitative variables, we used the Student’s t -test.
Assessment of Euroscore and SAPS III as hospital mortality predicted in cardiac surgery.
During this period we identified patients The patients’ baseline characteristics are shown in Table 1. CABG was performed in 57 patients However, an occasional risk factor was observed in other risk assessment scales modified Parsonnet.
Among these, 59 patients CABG was performed in 24 Diabetes mellitus was present in No patient had creatinine values in the range of 1. CABG was performed in 81 patients A total of 71 patients There were 34 patients with the minimum Parsonnet score: We found no statistically significant differences in either the study group or the validation group in terms of the type of surgical procedure, age, gender, associated diseases, EuroSCORE or Parsonnet score Table 1.
No patient in the study group or validation group died during the assessment period. This minimum-risk population of patients collected over 3 years of activity presented no in-hospital mortality.
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The hospital mortality of any surgical procedure is an extremely important factor cadiaca the clinical cardiologist and is the first obstacle to be overcome in order to achieve the benefits of surgery. Although the indications for coronary artery bypass and valvular surgery are presently well-defined in the clinical guidelines issued by various medical societies, 8,9 there are some situations in which the indication should be individualized.
As a result, scoring systems to predict the risk of operative mortality have been under development for more than a decade. One of their main uses is to provide a quality control mechanism to compare expected mortality with observed mortality. The EuroSCORE is one of the risk scoring systems that is gradually increasing in use, as it is less complex than other systems and originated within Europe with the participation of several Spanish hospitals.
Nevertheless, its diagnostic accuracy has not been definitively ascertained. The area under the curve values obtained by ROC analysis were below 0. In order to evaluate the quality of cardiac surgery, we decided to analyze the mortality of minimum-risk patients. Verifying low hospital mortality in this population is only an initial step in the analysis of quality. In this group of very low risk patients, a good outcome appears to be independent of the experience of the surgical teams. It is composed of men undergoing valve surgery with no other risk factors 2 pointswomen undergoing CABG with no other risk factor 1 point or with any risk factor adding one point 2 pointsand men undergoing CABG with 1 or 2 risk factors of 1 point or with one 2-point risk factor.
This was done because it is believed that even though operative mortality is higher particularly in CABG surgery, 16 not as much in valvular surgery 17 this mortality may be influenced by other risk factors that are absent or less frequent in men.
The predicted mortality range in the Euroscore low-risk group was 1. This article does not state whether or not women risk factor of 1 were included in this patient group. What is the percentage of patients with a minimum EuroScore? This is probably because our series included more valvular surgery than CABG and because the EuroSCORE is higher in valvular surgery this surgery type is automatically assigned 2 points.
We cannot compare our data with other Spanish series, since the last national registry for cardiac surgery dates back to 21 and does not include risk scale data. A multicenter study should be carried out to obtain a significantly higher number.
The objective of our study was to assess the minimum EuroSCORE in our setting; nevertheless, it would be worthwhile to further evaluate these findings in a multicenter registry.
Correlation of the EuroSCORE with the onset of postoperative acute kidney injury in cardiac surgery
We did not analyze other types of cardiac surgery. Ciruia surgery and the mechanical complications of AMI inherently imply a value above the minimum. Other diseases pericardial processes, etc. Surgery for congenital diseases in adults is infrequent and is known to involve low surgical risk.
From tothere was no mortality related to atrial septal defect surgery, the congenital condition most often treated surgically at our hospital unpublished data. Use of the mortality rate in a minimum-risk population — such as the population we identified by using the EuroSCORE — can be a quick, first step in assessing the quality of a particular surgical team.
If the mortality in this population differs substantially from the expected value, the surgical team should reflect at length on the outcome and define a strategy to improve it. If, in contrast, the mortality is along the lines of the expected levels, the initial impression of the team would be favorable.
In this case, additional analysis should still be performed to determine mortality in other risk groups. Furthermore, the awareness that a very low-risk population in which mortality is minimum or zero does exist is clinically useful for avoiding unnecessary deferral of an operation in appropriate cases.
Hospital Universitario Virgen de las Nieves. Calls from Spain 88 87 40 9 to 18 hours. Images subject to Copyright. Previous Article Vol July Next article. Abstract Introduction and objectives.
Risk of hospital death is one of the key factors considered by the clinical cardiologist when weighting indications for surgery. Risk estimation scales establish distinct levels of risk in quantitative terms.
The aim of cidugia present study was to investigate whether a low EuroSCORE value corresponds to low mortality in our setting. During we identified patients Fifty-seven of these patients underwent isolated CS, and 59 of them isolated VS. Intrahospital mortality was zero. In we identified 59 Intrahospital mortality during this period was again zero. A low EuroSCORE identifies a population of patients with cirugja risk of mortality after isolated coronary or valve surgery.
The score may be useful as a sentinel indicator in analyses of the complex issue of quality of cardiac surgery. Iberoamerican Cardiovascular Journals Editors’ Network.