The risk of morbidity following adult cardiac surgery can be predicted using readily available and objective clinical data. This score was developed at Rush-Presbyterian-St. Luke's Medical Center in Chicago.
Risk factors identified by logistic regression to be associated with serious morbidity:
(1) surgery performed as an emergency procedure
(2) age of patient
(3) presence of renal dysfunction
(4) history of previous myocardial infarction (MI) and time since occurrence
(5) gender
(6) reoperation
(7) presence of pulmonary hypertension
(8) presence of cerebrovascular disease
(9) type of surgery performed
(10) presence of congestive heart failure
(11) presence of left ventricular dysfunction
|
Risk Factor |
Finding |
Points |
|
emergency surgery |
no |
0 |
|
|
yes |
4 |
|
age |
< 65 years |
0 |
|
|
65 - 74 years |
1 |
|
|
>= 75 years |
2 |
|
renal dysfunction |
no |
0 |
|
|
yes |
2 |
|
previous MI |
none or > 6 months ago |
0 |
|
|
3 - 6 months ago |
1 |
|
|
< 3 months ago |
2 |
|
gender |
male |
0 |
|
|
female |
2 |
|
reoperation |
no |
0 |
|
|
yes |
2 |
|
pulmonary hypertension |
no |
0 |
|
|
yes |
2 |
|
cerebrovascular disease |
no |
0 |
|
|
yes |
2 |
|
type of surgery |
CABG only |
0 |
|
|
mitral or aortic valve |
1 |
|
|
multi-valve |
2 |
|
|
CABG + valve |
2 |
|
congestive heart failure |
no |
0 |
|
|
yes |
1 |
|
left ventricular dysfunction |
no |
0 |
|
|
yes |
1 |
(Table 5, page 40)
simplified clinical risk score =
= SUM(risk factor points)
Interpretation:
• minimum score: 0
• maximum score: 22
|
Score |
Risk Category |
Observed Morbidity |
|
0-5 |
low |
14.7% |
|
6-9 |
increased |
30.6% |
|
>= 10 |
high |
52.9% |
The morbidity and mortality for the clinical scores are shown in Figure 1 on page 39:
|
Score |
Approximate Morbidity |
Approximate Mortality |
|
0-3 |
12% |
3% |
|
4-5 |
20% |
4% |
|
6-7 |
30% |
6% |
|
8-9 |
40% |
12% |
|
10-11 |
55% |
21% |
|
>= 12 |
75% |
38% |
Purpose: To predict the risk of postoperative morbidity in a patient undergoing cardiac surger using a simplified clinical risk score.
Specialty: Cardiology, Surgery, general
Objective: risk factors, complication detection, surgery
ICD-10: I00-I02, I05-I09, I20-I25, I30-I52, Y83.2,
