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.