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Evaluation of Estimation of Physiologic Ability and Surgical Stress to predict in-hospital mortality in cardiac surgery

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Abstract

Purpose

Prediction of postoperative risk in cardiac surgery is important for cardiac surgeons and anesthesiologists. We generated a prediction rule for elective digestive surgery, designated as Estimation of Physiologic Ability and Surgical Stress (E-PASS). This study was undertaken to evaluate the accuracy of E-PASS in predicting postoperative risk in cardiac surgery.

Methods

We retrospectively collected data from patients who underwent elective cardiac surgery at a low-volume center (N = 291) and at a high-volume center (N = 784). Data were collected based on the variables required by E-PASS, the European system for cardiac operative risk evaluation (EuroSCORE), and the Ontario Province Risk Score (OPRS). Calibration and discrimination were assessed by the Hosmer–Lemeshow test and the area under the receiver operating characteristic curve (AUC), respectively. The ratio of observed-to-estimated in-hospital mortality rates (OE ratio) was defined as a measure of quality.

Results

In-hospital mortality rates were 7.6% at the low-volume center and 1.3% at the high-volume center, accounting for an overall mortality rate of 3.0%. AUC values to detect in-hospital mortality were 0.88 for E-PASS, 0.77 for EuroSCORE, and 0.71 for OPRS. Hosmer–Lemeshow analysis showed a good calibration in all models (P = 0.81 for E-PASS, P = 0.49 for EuroSCORE, and P = 0.94 for OPRS). OE ratios for the low-volume center were 0.83 for E-PASS, 0.70 for EuroSCORE, and 0.83 for OPRS, whereas those for the high-volume center were 0.26 for E-PASS, 0.14 for EuroSCORE, and 0.27 for OPRS.

Conclusions

E-PASS may accurately predict postoperative risk in cardiac surgery. Because the variables are different between cardiac-specific models and E-PASS, patients’ risks can be double-checked by cardiac surgeons using cardiac-specific models and by anesthesiologists using E-PASS.

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Authors and Affiliations

  1. Department of Anesthesiology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, 860-0008, Japan

    Atsushi Kotera

  2. Institute for Clinical Research, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Yoshio Haga

  3. Department of Cardiac and Vascular Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Junichi Kei & Minoru Okamoto

  4. Department of International Medical Cooperation, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Atsushi Kotera & Yoshio Haga

  5. Department of Anesthesiology, Kokura Memorial Hospital, Fukuoka, Japan

    Katsuhiro Seo

Authors
  1. Atsushi Kotera
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  2. Yoshio Haga
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  3. Junichi Kei
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  4. Minoru Okamoto
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  5. Katsuhiro Seo
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Correspondence to Atsushi Kotera.

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Kotera, A., Haga, Y., Kei, J. et al. Evaluation of Estimation of Physiologic Ability and Surgical Stress to predict in-hospital mortality in cardiac surgery. J Anesth 25, 481–491 (2011). https://doi.org/10.1007/s00540-011-1162-z

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  • DOI: https://doi.org/10.1007/s00540-011-1162-z

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