Abstract
ObjectiveReport the experience with the Society of Thoracic Surgeons scoring system in a Brazilian population submitted to isolated coronary artery bypass graft surgery.MethodsData were collected from January-2010 to December-2011, and analyzed to determine the performance of the Society of Thoracic Surgeons scoring system on the determination of postoperative mortality and morbidity, using the method of the receiver operating characteristic curve as well as the Hosmer-Lemeshow and the Chi-square goodness of fit tests. From the 1083 cardiac surgeries performed during the study period 659 represented coronary artery bypass graft procedures which are included in the present analysis. Mean age was 61.4 years and 77% were men.ResultsGoodness of fit tests have shown good calibration indexes both for mortality (X2=6.78, P=0.56) and general morbidity (X2=6.69, P=0.57). Analysis of area under the ROC-curve (AUC) demonstrated a good performance to detect the risk of death (AUC 0.76; P<0.001), renal failure (AUC 0.79; P<0.001), prolonged ventilation (AUC 0.80; P<0.001), reoperation (AUC 0.76; P<0.001) and major morbidity (AUC 0.75; P<0.001) which represents the combination of the assessed postoperative complications. STS scoring system did not present comparable results for short term hospital stay, prolonged length of hospital stay and could not be properly tested for stroke and wound infection.ConclusionSociety of Thoracic Surgeons scoring system presented a good calibration and discrimination in our population to predict postoperative mortality and the majority of the harmful events following coronary artery bypass graft surgery. Analysis of larger samples might be needed to further validate the use of the score system in Brazilian populations.
Highlights
Coronary artery bypass graft (CABG) surgery has been a widely used modality of treatment for coronary artery disease (CAD) for the last few decades
The burden of publications describing risk factors for a worse outcome evolved with the use of large sets of data collected from patients submitted to surgery over distinct periods of time
The Society of Thoracic Surgeons (STS) started a visionary effort of collecting data from patients submitted to cardiothoracic surgery all over the United States of America which culminated with the development of the STS National Adult Cardiac Surgery Database, a databank that accounts for more than four and a half millions of surgically treated patients [3,4]
Summary
Coronary artery bypass graft (CABG) surgery has been a widely used modality of treatment for coronary artery disease (CAD) for the last few decades. Postoperative outcomes of CABG have progressively improved as a consequence of new technologies, surgical techniques, postoperative care, and because of better control of specific risk factors, before, during and after surgery [1]. The burden of publications describing risk factors for a worse outcome evolved with the use of large sets of data collected from patients submitted to surgery over distinct periods of time. The Society of Thoracic Surgeons (STS) started a visionary effort of collecting data from patients submitted to cardiothoracic surgery all over the United States of America which culminated with the development of the STS National Adult Cardiac Surgery Database, a databank that accounts for more than four and a half millions of surgically treated patients [3,4]. Using the information recorded in that bank, accurate risk scores for morbidity and mortality were developed with help of multiple logistic regression models [5,6]
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