Supplementing prediction by EuroSCORE with social and patient reported
measures among patients undergoing cardiac surgery
Abstract
Objectives The risk of poor outcomes is traditionally attributed to
biological and physiological processes in cardiac surgery. However,
evidence exists that other factors, such as emotional, behavioural,
social and functional, are predictive of poor outcomes. Objectives were
to evaluate the predictive value of several emotional, social,
functional and behavioural factors on four outcomes; death within 90
days, prolonged stay in intensive care, prolonged hospital admission and
readmission within 90 days following cardiac surgery. Methods This
prospective study included adults undergoing cardiac surgery 2013-2014,
including information on register-based socio-economic factors and
self-reported health in a nested subsample. Logistic regression analyses
to determine the association and incremental value of each candidate
predictor variable were conducted. Multiple regression analyses were
used to determine the incremental value of each candidate predictor
variable, as well as discrimination and calibration based on AUC and
Brier score. Results Of 3217 patients, 3% died, 9% had prolonged
intensive care stay, 51% had prolonged hospital admission and 39% were
readmitted to hospital. Patients living alone (OR, 1.19; 95% CI,
1.02-1.38), with lower educational levels (1.27; 1.04-1.54) and low
health-related quality of life (1.43; 1.02-2.01) had prolonged hospital
admission. Analyses revealed living alone as predictive of prolonged ICU
stay (Brier, 0.08; AUC, 0.68), death (0.03; 0.71) and prolonged hospital
admission (0.24; 0.62). Conclusion Living alone was found to supplement
EuroSCORE in predicting death, prolonged hospital admission and
prolonged ICU stay following cardiac surgery. Low educational level and
impaired health-related quality of life were, furthermore, predictive of
prolonged hospital admission.