Introduction

In cardiac surgery, surgical advances and an increasingly older population have resulted in more complex and high-risk patients being offered surgical procedures. Risk assessment in cardiac surgery aims to reduce poor outcomes by including individual differences in patient profiles and surgical complexity, as well as in surgeons’ technical performance (1).
There are several prognostic screening tools currently available for patients undergoing cardiac surgery. Established clinical risk factors included are history of previous heart surgery, the severity of coronary artery disease, and the degree of comorbidity. In most of Europe, EuroSCORE (2,3) is used in clinical practice. The total risk is calculated by adding scores from several risk factors (e.g. chronic pulmonary disease, serum creatinine and left ventricular dysfunction) resulting in a predicted percentage of surgical mortality. The score is defined to distinguish low (<3), moderate (3-5) and high-risk (6+) groups (2,3). However, according to several validation studies (4–6) EuroSCORE is inaccurate in predicting mortality rates. Increasing evidence indicates that non-physiological factors, such as patients’ emotional, behavioural, social and functional status are predictive of poor outcomes following cardiac surgery (7). Thus, disparities exist in traditional risk assessment in cardiac surgery designed to advise patients of their operative risk of death.
The complex nature of risk assessment and the lack of parameters representing the emotional, social, functional and behavioural lives of patients point toward the need for new definitions of risk and new approaches to risk management in cardiac surgery. The current study is a comprehensive research project developing a risk stratification model as a supplement to EuroSCORE. Emotional, social, functional and behavioural factors will be included to investigate the predictive value on mortality, prolonged stay in the intensive care unit (ICU), prolonged hospitalisation and readmissions within 90 days after cardiac surgery.‬ ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬
The aim of this study is therefore to describe the predictive value of emotional, social, functional and behavioural factors and outcomes of death, prolonged length of stay in the ICU, prolonged length of hospital admission and readmissions following cardiac surgery. The potential predictive factors are tested as a supplement to EuroSCORE.