Risk Scores in Cardiac Surgery

2017 ◽  
pp. 33-66
Author(s):  
Dietmar Boethig ◽  
Jeffrey Phillip Jacobs
Keyword(s):  
Cardiac Surgery ◽  
Risk Scores

scholarly journals Cardiac surgery in the elderly: What goals of care?

2017 ◽  
Vol 87 (2) ◽  
Author(s):  
Alessandra Pratesi ◽  
Francesco Orso ◽  
Camilla Ghiara ◽  
Aldo Lo Forte ◽  
Anna Chiara Baroncini ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
The Elderly ◽  
Risk Scores ◽  
Frailty Phenotype ◽  
Mortality And Morbidity ◽  
Geriatric Cardiology ◽  
Patient Reported ◽  
Short Term Mortality ◽  
Surgery In The Elderly

<p>At present, the majority of cardiac surgery interventions have been performed in the elderly with successful short-term mortality and morbidity, however significant difficulties must to be underlined about our capacity to predict long-term outcomes such as disability, worsening quality of life and loss of functional capacity.<br />The reason probably resides on inability to capture preoperative frailty phenotype with current cardiac surgery risk scores and consequently we are unable to outline the postoperative trajectory of an important patients’ centered outcome such as disability free survival. In this perspective, more than one geriatric statements have stressed the systematic underuse of patient reported outcomes in cardiovascular trials even after taking account of their relevance to older feel and wishes. Thus, in the next future is mandatory for geriatric cardiology community closes this gap of evidences through planning of trials in which patients’ centered outcomes are considered as primary goals of therapies as well as cardiovascular ones.</p>

scholarly journals Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery

2012 ◽  
Vol 3 (4) ◽  
pp. 278 ◽  
Author(s):  
Xue-zhong Xing ◽  
Hai-jun Wang ◽  
Chu-lin Huang ◽  
Quan-hui Yang ◽  
Shi-ning Qu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cancer Patients ◽  
Critically Ill ◽  
Injury Risk ◽  
Kidney Injury ◽  
Risk Scores

ICU outcomes in adult cardiac surgery patients in relation to ultrafiltration type

Perfusion ◽  
2008 ◽  
Vol 23 (2) ◽  
pp. 79-87 ◽  
Author(s):  
JL Pérez-Vela ◽  
E Ruiz-Alonso ◽  
F Guillén-Ramírez ◽  
MT García-Maellas ◽  
E Renes-Carreño ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Previous History ◽  
Adult Patients ◽  
Risk Scores ◽  
Neurologic Complications ◽  
Reliable Technique ◽  
Elective Cardiac Surgery ◽  
Fluid Removal ◽  
Extubation Time

Ultrafiltration (UF) is used to ameliorate the deleterious effects of cardiopulmonary bypass (CPB) in cardiac surgery patients. There are two different methods; conventional ultrafiltration (CUF), performed during CPB, and modified ultrafiltration (MUF), performed after CPB is finished. It has not been established which is better, and controversy remains regarding the optimal UF strategy. The objective of this study was to evaluate if MUF alone, or combined with CUF, could achieve greater fluid removal and contribute to better postoperative clinical outcomes. Also, the potential technique complications were studied. This was a prospective study which enrolled 125 consecutive adult patients receiving elective cardiac surgery with CPB. We analysed three treatment groups: MUF, CUF and both. Ultrafiltration was performed using a non-pulsatile CPB with a non-occlusive roller pump, Sarns 9000®, and a polysulfone ultrafilter, Minntech®. We studied pre- and intraoperative data and immediate postoperative clinical outcomes: total amount of drainage, transfusion needs, respiratory outcome, cardiac, renal and neurologic complications. Statistical analysis was performed using SPSS 11.0. All three groups were homogeneous and did not have differences in terms of demographic factors, previous history, risk scores, intervention and operative data. Volume of filtrate removal in the group which applied both techniques was larger than in the CUF or MUF groups alone (2569±823 vs 1679±651 vs 1398±353 ml, respectively, p=0.0001); however, despite this difference, there was no difference in the immediate postoperative fluid balances between the groups (596±1244 vs 880±1054 vs 986±1190 ml, p=0.30). Respiratory parameters and postoperative morbidity data analysed (total amount of drainage, transfusion needs, haemoglobin, acute lung injury, time with inotropes, ventricular failure, cardiogenic shock, neurologic complications and renal failure) were similar in all three groups, without statistical differences. Extubation time (10±7 vs 8.9±3 vs 9.4±7.9 hours, p=0.72) and ICU stay (56.6±72 vs 66.5±109 vs 44.2±25 hours, p=0.43) also were similar between the groups. We did not find any technique complication associated with any patient. In the present study, with adult patients receiving elective cardiac surgery, the combined ultrafiltration group had a larger fluid removal. However, neither type of ultrafiltration nor amount of filtered volume was accompanied by different postoperative ICU clinical outcomes. Ultrafiltration was considered a safe and reliable technique, with no related complications.

scholarly journals Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity

2012 ◽  
Vol 5 (2) ◽  
pp. 222-228 ◽  
Author(s):  
Jonathan Afilalo ◽  
Salvatore Mottillo ◽  
Mark J. Eisenberg ◽  
Karen P. Alexander ◽  
Nicolas Noiseux ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Elderly Patients ◽  
Risk Scores ◽  
Major Morbidity ◽  
Risk Of Mortality

scholarly journals 315 Cardiac surgery in the elderly: the underestimate role of frailty in the decision making

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Pasquale Campana ◽  
Maddalena Conte ◽  
Maria Emiliana Palaia ◽  
Laura Petraglia ◽  
Adele Ferro ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Frailty Index ◽  
The Elderly ◽  
Risk Scores ◽  
Surgical Risk ◽  
The Impact

Abstract Aims Elders represent the most common population with indication to cardiac surgery, also presenting the highest mortality/disability after interventions. Both for valve and coronary artery surgery the estimation of the surgical risk, including the frailty assessment, is recommended to guide the decision making. However, frailty results not exhaustively assessed by the commonly used surgical risk scores such as EuroSCORE I-II and score of the Society of Thoracic Surgeons and is mostly used the Kat’s Index (included in the latest European guidelines). This study aims at establishing the feasibility and the value of a Comprehensive Geriatric Assessment (CGA) in elderly undergoing cardiac surgery. Methods From June 2021we consecutively enrolled 50 elderly patients undergoing cardiac surgery (age &gt; 65 years old). All patients underwent CGA with an expert geriatrician and the demographic, biometrics, clinical and echocardiographic data were collected. We evaluated frailty and disability (Kats index, Barthel Index and Frailty Index FI), cognitive status (Montreal Cognitive Assessment MOCA, Mini Mental State Examination MMSE and Geriatric Depression Scale), physical status (Tinetti test, Short Performance Physical Battery SPPB, Physical Activity Scale for the Elderly PASE and 6-min Walking test), delirium condition, sarcopenia and nutritional status (Mini-Nutritional Assessment MNA). A clinical, echocardiographic, and geriatric 3-month follow-up is planned. In particular, we are evaluating the impact of frailty, assessed by CGA, on peri-surgical outcome and the potential additive value of a CGA on the commonly used surgical risk-scores and Kat’s Index. Furthermore, we are assessing the impact of cardiac surgery of frail elderly at GCA. Results The CGA was feasible in all patients and lasted 1 h/patient. In our baseline data, only 23% of the enrolled patients resulted ‘frail’ according to Kat’s Index. However, in the remaining 77% of the study population, the CGA have identified 30% of patients with increased frailty index and 30% with disability, assessed by Barthel Index and physical function indexes (PASE and SPPB). In these patient, frailty and disability were associated to impaired nutritional status, assessed at MNA. Furthermore, 40% of the patients of this group resulted sarcopenic at the hand grip test. The cognitive valuation has shown a cognitive impairment in the 20% of patients at the MMSE and the 70 % at the MOCA. Of note, the 40% of the patients resulted to suffer of depression, not diagnosed before the GCA. At mid-November 2021 the follow-up will be completed. Conclusions The preliminary results of the presents study suggest that in patients undergoing cardiac surgery frailty is currently underdiagnosed. The follow-up analysis will establish if a CGA has an additive value on common surgical risk estimators. This study has a potential impact on the risk stratification of elderly patients undergoing invasive procedures and defines the need of a geriatrician in the heart team.

scholarly journals Evaluation of risk scores in predicting perioperative blood transfusions in adult cardiac surgery

2019 ◽  
Vol 22 (1) ◽  
pp. 73 ◽  
Author(s):  
NaveenG Singh ◽  
NR Madhu Krishna ◽  
PS Nagaraja ◽  
SN Nanjappa ◽  
KarthikNarendra Kumar ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Risk Scores ◽  
Blood Transfusions ◽  
Adult Cardiac Surgery

One-year mortality increases four-fold in frail patients undergoing cardiac surgery

2020 ◽  
Vol 59 (1) ◽  
pp. 192-198
Author(s):  
Caroline Bäck ◽  
Mads Hornum ◽  
Morten Buus Jørgensen ◽  
Ulver Spangsberg Lorenzen ◽  
Peter Skov Olsen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cox Proportional Hazards ◽  
Hospital Length Of Stay ◽  
Risk Scores ◽  
Ageing Population ◽  
Clinical Trial Registration ◽  
Mortality And Morbidity ◽  
Frail Patients ◽  
Increased Risk ◽  
The Impact

Abstract OBJECTIVES An increased focus on biological age, ‘frailty’, is important in an ageing population including those undergoing cardiac surgery. None of the existing surgery risk scores European System for Cardiac Operative Risk Evaluation II or Society of Thoracic Surgeons score incorporates frailty. Therefore, there is a need for an additional risk score model including frailty and not simply the chronological age. The aim of this study was to evaluate the impact of frailty assessment on 1-year mortality and morbidity for patients undergoing cardiac surgery. METHODS A total of 604 patients aged ≥65 years undergoing non-acute cardiac surgery were included in this single-centre prospective observational study. We compared 1-year mortality and morbidity in frail versus non-frail patients. The Comprehensive Assessment of Frailty (CAF) score was used: This is a score of 1–35 determined via minor physical tests. A CAF score ≥11 indicates frailty. RESULTS The median age was 73 years and 79% were men. Twenty-five percent were deemed frail. Frail patients had four-fold, odds ratios 4.63, 95% confidence interval (CI) 2.21–9.69; P &lt; 0.001 increased 1-year mortality and increased risk of postoperative complications, i.e. surgical wound infections and prolonged hospital length of stay. A univariable Cox proportional hazards regression showed that an increased CAF score was a risk factor of mortality at any time after undergoing cardiac surgery (hazards ratios 1.11, 95% CI 1.07–1.14; P &lt; 0.001). CONCLUSIONS CAF score identified frail patients undergoing cardiac surgery and was a good predictor of 1-year mortality. Clinical trial registration number NCT02992587.

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