Risk stratification score to determine long-term outcomes based
on post-operative complications following cardiac surgery – need of the
hour?
Siddharth Pahwa, MD1
1 – Department of Cardiovascular Surgery and Thoracic Surgery,
University of Louisville, KY
No sources of funding and conflicts of interest to disclose.
Corresponding author:
Siddharth Pahwa, MD
Department of Cardiovascular and Thoracic Surgery
University of Louisville, KY
Phone – 502-588-7600
Email – siddharth.pahwa@uoflhealth.org
Word count – 499
Risk models were developed to provide clinicians and hospitals with a
tool to evaluate risk-adjusted outcomes and to guide quality
improvement. The Society of Thoracic Surgeons (STS) Predicted Risk of
Mortality (PROM) is the most commonly used risk algorithm, others being
the EuroSCORE logistic and additive algorithm and the Ambler Risk Score.
These models utilize pre-operative patient characteristics to predict
operative risk and early outcomes. Although a great deal of effort has
gone into models to predict short-term patient outcomes after common
cardiac operations, there has been relatively little effort to develop a
statistical algorithm to predict long-term outcomes. Moreover, no risk
model takes into account early post-operative complications to construct
an algorithm to predict long-term outcomes.
Dokollari and colleagues in their recent invited commentary rightly
pointed out that there is a need for a clinical risk prediction model
for post-operative complications.1 Recently published
data by Seese and colleagues reported the impact of the STS-defined
major morbidities (prolonged ventilation, deep sternal wound infection,
renal failure, re-operation and stroke) on long-term
outcomes.2 Pahwa and colleagues further reported the
impact of seventeen common post-operative complications and analyzed
their impact on long-term survival.3 The effect of
multiple complications and various combinations of complications were
also investigated and, understandably, the greater the number of
complications, the worse was the survival.2, 3
The formulation of a risk stratification score based on post-operative
complications following common cardiac surgical procedures may be used
to estimate the likelihood of long-term survival for individual
complications, as well as various permutations and combinations of
complications. This may have profound implications in devising
strategies to prevent the most devastating combination of complications.
Also, this may assist in informing patients and families of the
predicted survival after a particular complication or a combination of
complications. As Dokollari et all pointed out, there is impetus towards
the direction of formulating a risk stratification score, and this may
indeed be the need of the hour.1
References
1. Dokollari A, Cameli M, Kalra DK, Gelsomino S, Bisleri G, Bonacchi M.
Success in long-term outcome after cardiac surgery: Rise from an
uncomplicated immediate postoperative course. J Card Surg. 2021 Mar 9.
doi: 10.1111/jocs.15467.
2. Seese L, Sultan I, Gleason TG, Navid F, Wang Y, Thoma F, Kilic A. The
Impact of Major Postoperative Complications on Long-Term Survival After
Cardiac Surgery. Ann Thorac Surg. 2020 Jul;110(1):128-135. doi:
10.1016/j.athoracsur.2019.09.100.
3. Pahwa S, Bernabei A, Schaff H, Stulak J, Greason K, Pochettino A,
Daly R, Dearani J, Bagameri G, King K, Viehman J, Crestanello J. Impact
of postoperative complications after cardiac surgery on long-term
survival. J Card Surg. 2021 Mar 9. doi: 10.1111/jocs.15471.