Risk stratification score to determine long-term outcomes based on
post-operative complications following cardiac surgery -- need of the
hour?
Abstract
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. 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.