Biagioli et al developed models for predicting morbidity following coronary artery bypass graft (CABG) surgery. This can help identify patients who are at higher risk of complications and to compare outcomes. The authors are from University of Siena in Siena, Italy.
Endpoint: Post-operative morbidity - one or more of the following (page 4 of 13):
(1) cardiovascular complications (myocardial infarction, low cardiac output, severe arrhythmia, cardiopulmonary resuscitation)
(2) respiratory complications (prolonged ventilatory support, ARDS, reintubation, tracheostomy
(3) neurological complications (diffuse encephalopathy, focal brain lesion, delayed failure to awaken)
(4) renal complications (acute renal failure, need for dialysis)
(5) infectious complications (pneumonia, mediastinitis, wound infection, sepsis, septic shock)
(6) hemorrhagic complications (bleeding necessitating re-operation)
Parameters in the partially customized score model:
(1) weight in kilograms
(2) age in years
(3) oxygen delivery index in mL per minute per square meter BSA (see 08.06.04)
(4) presence of peripheral vascular disease and/or carotid artery disease
(5) preoperative serum creatinine in mg/dL
(6) white blood cell (WBC) count >= 12,000 per µL
(7) redo procedure
(8) emergency surgery (unstable angina, unstable hemodynamics, ischemic valve dysfunction)
(9) preoperative intra-aortic balloon pump (IABP)
(10) duration of cardiopulmonary bypass
(11) inotropic support after cardiopulmonary bypass
(12) intra-aortic balloon pump (IABP) required after CABG
|
Parameter |
Finding |
Coefficient |
Points |
|
weight kilograms |
> 72 kg |
0 |
0 |
|
|
<= 72 kg |
0.24 |
1 |
|
age in years |
< 70 years |
0 |
0 |
|
|
>= 70 years |
0.44 |
1 |
|
oxygen delivery index |
> 300 mL/min/sq m |
0 |
0 |
|
|
<= 300 mL/min/sq m |
1.19 |
2 |
|
vascular disease |
absent |
0 |
0 |
|
|
present |
0.92 |
2 |
|
preop serum creatinine |
< 1.2 mg/dL |
0 |
0 |
|
|
>= 1.2 mg/dL |
0.36 |
1 |
|
WBC count |
< 12,000 per µL |
0 |
0 |
|
|
>= 12,000 per µL |
0.21 |
1 |
|
redo procedure |
no |
0 |
0 |
|
|
yes |
3.15 |
6 |
|
emergency surgery |
no |
0 |
0 |
|
|
yes |
0.50 |
1 |
|
preoperative use IABP |
no |
0 |
0 |
|
|
yes |
1.14 |
2 |
|
duration cardiopulmonary bypass |
< 2 hours |
0 |
0 |
|
|
>= 2 hours |
0.53 |
1 |
|
inotropic support after |
no |
0 |
0 |
|
|
yes |
1.07 |
2 |
|
IABP after CABG |
no |
0 |
0 |
|
|
yes |
3.48 |
7 |
total sum of coefficients = X =
= SUM(coefficients for all 12 parameters) - 5.65
probability of morbidity after CABG =
= 1 / (1 + EXP((-1) * (X))
total point sum =
= SUM(points for all 12 parameters)
Interpretation:
• minimum total point score: 0
• maximum total point score: 27
• A total point score >= 4 was associated with significant morbidity (high risk; see footnote Table 5).
Specialty: Cardiology, Surgery, general
ICD-10: ,
