Huijskes et al developed models for predicting outcomes following coronary artery bypass graft and/or cardiac valve surgery. One model describes the risk for an extended length of stay (ELOS) in the intensive care unit (ICU) following the surgery.. The authors are from Amphia Hospital in Breda, The Netherlands.
Parameters:
(1) age in years
(2) gender
(3) neurological dysfunctional disease (history of transient ischemic attack, stroke)
(4) serum creatinine in µmol/L
(5) hemoglobin as percent of the lower limit of normal (LLN)
(6) left ventricular ejection fraction
(7) pulmonary hypertension
(8) history of previous cardiac surgery
(9) myocardial infarction (AMI) in the past 24 hours
(10) failed percutaneous coronary intervention (PCI)
(11) timing for the surgery
(12) critical preoperative state from the Euroscore
(13) type of surgery
|
Parameter |
Finding |
Points |
|---|---|---|
|
age |
<=60 |
0 |
|
|
> 60 |
see below |
|
gender |
male |
0 |
|
|
female |
2 |
|
neurological dysfunction |
no |
0 |
|
|
yes |
2 |
|
serum creatinine |
< 150 µmol/L |
0 |
|
|
150 to 200 µmol/L |
4 |
|
|
> 200 µmol/L |
8 |
|
hemoglobin |
> 90% of LLN |
0 |
|
|
80 to 90% of LLN |
1 |
|
|
< 80% of LLN |
2 |
|
left ventricular ejection fraction |
fair to good (>= 30%) |
0 |
|
|
poor (< 30%) |
4 |
|
pulmonary hypertension |
no |
0 |
|
|
yes |
3 |
|
history of previous cardiac surgery |
no |
0 |
|
|
yes |
4 |
|
AMI in past 24 hours |
no |
0 |
|
|
yes |
4 |
|
failed PCI |
no |
0 |
|
|
yes |
3 |
|
timing for the surgery |
routine or urgent |
0 |
|
|
emergency |
3 |
|
critical preoperative state |
no |
0 |
|
|
yes |
3 |
|
type of surgery |
combined CABG and mitral valve surgery |
6 |
|
|
combined CABG and aortic valve surgery |
2 |
|
|
other |
0 |
points for age over 60 =
= ROUNDUP((age) – 60)/5,0)
total score =
= SUM(points for all 13 parameters)
Interpretation:
• minimum score: 0
• maximum score 40 or more
• The higher the score the greater the risk for an extended stay in the ICU.
|
Total Score |
Risk |
|---|---|
|
0 to 3 |
low |
|
4 to 6 |
low to moderate |
|
7 or 8 |
moderate |
|
9 to 11 |
moderate to high |
|
12 or more |
high |
The authors also gave the equation from multivariate analysis:
|
Parameter |
Beta |
|---|---|
|
age, per 5 years after 60 years of age |
0.34 |
|
female gender |
0.51 |
|
neurological dysfunctional disease |
0.52 |
|
serum creatinine |
1.15 |
|
hemoglobin |
0.26 |
|
poor left ventricular ejection fraction |
0.97 |
|
pulmonary hypertension |
0.72 |
|
history of prior cardiac surgery |
0.96 |
|
AMI in past 24 hours |
0.97 |
|
failed PCI |
0.74 |
|
emergency procedure |
0.91 |
|
critical preoperative state |
0.82 |
|
combined CABG and mitral valve procedure |
1.68 |
|
combined CABG and aortic valve procedure |
0.58 |
|
coefficient |
-4.80 |
Specialty: Cardiology, Surgery, general
ICD-10: ,
