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Ann Thorac Surg 2005;79:1908
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Invited commentary

Critical Care Services, Baystate Medical Center, Springfield, Tufts University School of Medicine, Porter 2, 759 Chestnut St, Springfield, MA 01199

(E-mail: thomas.higgins{at}bhs.org).

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is integrated into clinical practice in Europe, similar to the use of The Society of Thoracic Surgeons model in the United States. Because patient mix affects the performance of severity of illness models, customizing a model for geographic area is generally appropriate. Some severity of illness models are designed for coronary artery bypass grafting (CABG) patients only; others for all cardiac surgical cases. Preoperative and intensive care unit admission models contain different predictor variables and are suited for evaluating different epochs of a patient’s continuum of care. Models become especially valuable when they are useful in multiple situations.

Toumpoulis and colleagues examine the utility of the EuroSCORE, designed to adjust perioperative mortality results by patient condition, to the prediction of longer term, ie, 5-year survival in a subset of cardiac surgical patients, specifically those with isolated valve or combined CABG and heart valve surgery. Estimated 5-year survival rates fall off with increasing risk profiles. Given that many of the factors scored (age, chronic pulmonary disease, extracardiac arteriopathy, neurologic dysfunction, renal function, pulmonary hypertension, left ventricular dysfunction) are general predictors of longevity, it is not surprising that the EuroSCORE has utility in long-term prognosis after surgery. As the authors have demonstrated, age alone is a strong predictor for long-term mortality, but less discriminating than the use of the EuroSCORE.

An estimated 5-year survival rate of 90% in the lowest risk quartile should be reassuring to patients and families who raise the question "Is it worth it?" when considering an elective operation. Five-year survival of 55% in the highest risk quartile is more sobering, but still imparts valuable information. Because factors other than medical care affect survival, it would be difficult to use long-term outcome results to evaluate quality of care. Investigating differences in severity-adjusted long-term mortality rates may shed light on the impact of care decisions such as type of anticoagulation, frequency of follow-up visits, exercise and rehabilitation programs, and regional differences in the intensity of care.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas L. Higgins Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Higgins, T. L. Search for Related Content PubMed PubMed Citation Articles by Higgins, T. L.