Is EuroSCORE II still a reliable predictor for cardiac surgery mortality in 2022? A retrospective study study

Giorgio Mastroiacovo; Alice Bonomi; Monica Ludergnani; Matteo Franchi; Riccardo Maragna; Sergio Pirola; Andrea Baggiano; Alice Caglio; Gianluca Pontone; Gianluca Polvani; Luca Merlino

doi:10.1093/ejcts/ezad294

Is EuroSCORE II still a reliable predictor for cardiac surgery mortality in 2022? A retrospective study study

Eur J Cardiothorac Surg. 2022 Jan 1;64(3):ezad294. doi: 10.1093/ejcts/ezad294.

Authors

Giorgio Mastroiacovo¹, Alice Bonomi², Monica Ludergnani³, Matteo Franchi^{2

4

5}, Riccardo Maragna⁶, Sergio Pirola¹, Andrea Baggiano^{6

7}, Alice Caglio³, Gianluca Pontone⁶, Gianluca Polvani^{1

8}, Luca Merlino⁹

Affiliations

¹ IRCCS Centro Cardiologico Monzino, Department of Cardiovascular Surgery, Milan, Italy.
² Department of Statistics, IRCCS Centro Cardiologico Monzino, Milan, Italy.
³ Healthcare Management, IRCCS Centro Cardiologico Monzino, Milan, Italy.
⁴ National Centre for Healthcare Research & Pharmacoepidemiology, Head Office at the Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
⁵ Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
⁶ Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138, Milan, Italy.
⁷ Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy.
⁸ Department of Surgical and Dental Biomedical Sciences, University of Milan, Italy.
⁹ Head of Healthcare Management, IRCCS Centro Cardiologico Monzino, Milan, Italy.

Abstract

Objectives: The European System for Cardiac Operation Risk Evaluation II (EuroSCORE II) is the most common tool used to evaluate the perioperative risk of mortality after cardiac surgery in Europe, and its use is currently recommended by the relevant guidelines. However, recently, its role has been questioned: Several papers have suggested that these algorithms may no longer be adequate for risk prediction due to an overestimation of adult cardiac surgical risk. Our goal was to validate the EuroSCORE II in the prediction of 30-day in-hospital mortality in patients undergoing open cardiac surgery in a high-volume hospital.

Methods: In this retrospective cohort study, we included all patients who underwent cardiac surgery from January 2016 to May 2022 within the departments of cardiac surgery of the Monzino Cardiology Centre in Milan, Italy. We evaluated the discrimination power of the EuroSCORE II by using the receiver operating characteristic curve and the corresponding area under the curve. We performed calibration plots to assess the concordance between the model's prediction and the observed outcomes.

Results: A total of 4,034 patients were included (mean age = 65.1 years; 68% males), of which 674 (16.7%) underwent isolated coronary artery bypass grafting. The EuroSCORE II showed a good discrimination power in predicting 30-day in-hospital mortality (area under the curve = 0.834). However, for interventions performed in an elective setting, very low values of the EuroSCORE II overestimated the observed mortality, whereas for interventions performed in an emergency setting, EuroSCORE II values above 10 extensively underestimated the observed mortality.

Conclusions: Our study suggests that the EuroSCORE II seems not to be a reliable score in estimating the true risk of death, especially in high-risk patients.

Keywords: EuroSCORE II; cardiac surgery; post-operative mortality; validation study.