Predictive Risk Model of Catalonia for Open Heart Surgery Mortality

Description

A score for predicting mortality in patients undergoing open heart surgery was developed in Catalonia (Barcelona), Spain. It can be used to compare surgical outcomes at different hospitals by separating patients into mortality risk groups. The authors are from the Catalan Agency for Health Technology Assessment, Catalan Institute of Oncology, and Autonomous University of Barcelona.

Development: The total patient sample was 1309 procedures at 7 hospitals.

Parameters for score:

(1) age

(2) history of recent myocardial infarction

(3) New York functional class

(4) liver disease

(5) left ventricular aneurysm

(6) serum creatinine

(7) cardiogenic shock

(8) presurgical mechanical ventilation

(9) priority for surgery

(10) reoperation

(11) mitral and/or tricuspid valve surgery

(12) thoracic aortic surgery

(13) combined valve and coronary artery surgery

Parameter	Finding	Odds Ratio	Points
age in years	< 70		0
	70 - 79	2.06	7
	>= 80	5.22	17
recent myocardial infarction		2.61	10
functional class	1 or 2		0
	3	1.46	4
	4	2.61	10
liver disease		2.31	8
left ventricular aneurysm		3.03	11
creatinine	< 1.5 mg/dL		0
	>= 1.5 mg/dL	2.29	8
cardiogenic shock		3.67	13
presurgical mechanical ventilation		1.97	7
priority	urgent or emergent	1.37	4
	routine		0
reoperation	first	2.40	9
	second	4.27	15
mitral valve surgery		1.80	6
tricuspid valve surgery		2.74	10
thoracic aortic surgery		3.45	12
combined valve and coronary surgery		1.95	7

where:

• The odds ratios are from the logistic regression analysis (Table 3, page 419)

clinical severity score =

= SUM(points present for parameters)

Interpretation:

• minimum score: 0

• maximum score: 138

Score	Risk Group	Estimated Mortality
0 - 10	low risk	4.2%
11 - 15	fair risk	7.3%
16 - 20	high risk	13.2%
21 - 30	very high risk	19.2%
>= 31	extremely high risk	54.4%

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Description

Specialty

ICD-10