TY - JOUR
T1 - Dynamics in cardiac surgery
T2 - trends in population characteristics and the performance of the EuroSCORE II over time
AU - Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration
AU - van Dijk, Wouter B
AU - Leeuwenberg, Artuur M
AU - Grobbee, Diederick E
AU - Siregar, Sabrina
AU - Houterman, Saskia
AU - Daeter, Edgar J
AU - de Vries, Martine C
AU - Groenwold, Rolf H H
AU - Schuit, Ewoud
AU - van Boven, W.J.P.
N1 - Funding Information: The authors would like to mention their gratitude to the Netherlands Heart Registration for making available the data substantiating this work. This work was supported by the Netherlands Organisation for Health Research and Development (ZonMW) (grant number 91217027). Funding Information: This work was supported by the Netherlands Organisation for Health Research and Development (ZonMW) (grant number 91217027). Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - OBJECTIVES: The aim of this study was to investigate the performance of the EuroSCORE II over time and dynamics in values of predictors included in the model.METHODS: A cohort study was performed using data from the Netherlands Heart Registration. All cardiothoracic surgical procedures performed between 1 January 2013 and 31 December 2019 were included for analysis. Performance of the EuroSCORE II was assessed across 3-month intervals in terms of calibration and discrimination. For subgroups of major surgical procedures, performance of the EuroSCORE II was assessed across 12-month time intervals. Changes in values of individual EuroSCORE II predictors over time were assessed graphically.RESULTS: A total of 103 404 cardiothoracic surgical procedures were included. Observed mortality risk ranged between 1.9% [95% confidence interval (CI) 1.6-2.4] and 3.6% (95% CI 2.6-4.4) across 3-month intervals, while the mean predicted mortality risk ranged between 3.4% (95% CI 3.3-3.6) and 4.2% (95% CI 3.9-4.6). The corresponding observed:expected ratios ranged from 0.50 (95% CI 0.46-0.61) to 0.95 (95% CI 0.74-1.16). Discriminative performance in terms of the c-statistic ranged between 0.82 (95% CI 0.78-0.89) and 0.89 (95% CI 0.87-0.93). The EuroSCORE II consistently overestimated mortality compared to observed mortality. This finding was consistent across all major cardiothoracic surgical procedures. Distributions of values of individual predictors varied broadly across predictors over time. Most notable trends were a decrease in elective surgery from 75% to 54% and a rise in patients with no or New York Heart Association I class heart failure from 27% to 33%.CONCLUSIONS: The EuroSCORE II shows good discriminative performance, but consistently overestimates mortality risks of all types of major cardiothoracic surgical procedures in the Netherlands.
AB - OBJECTIVES: The aim of this study was to investigate the performance of the EuroSCORE II over time and dynamics in values of predictors included in the model.METHODS: A cohort study was performed using data from the Netherlands Heart Registration. All cardiothoracic surgical procedures performed between 1 January 2013 and 31 December 2019 were included for analysis. Performance of the EuroSCORE II was assessed across 3-month intervals in terms of calibration and discrimination. For subgroups of major surgical procedures, performance of the EuroSCORE II was assessed across 12-month time intervals. Changes in values of individual EuroSCORE II predictors over time were assessed graphically.RESULTS: A total of 103 404 cardiothoracic surgical procedures were included. Observed mortality risk ranged between 1.9% [95% confidence interval (CI) 1.6-2.4] and 3.6% (95% CI 2.6-4.4) across 3-month intervals, while the mean predicted mortality risk ranged between 3.4% (95% CI 3.3-3.6) and 4.2% (95% CI 3.9-4.6). The corresponding observed:expected ratios ranged from 0.50 (95% CI 0.46-0.61) to 0.95 (95% CI 0.74-1.16). Discriminative performance in terms of the c-statistic ranged between 0.82 (95% CI 0.78-0.89) and 0.89 (95% CI 0.87-0.93). The EuroSCORE II consistently overestimated mortality compared to observed mortality. This finding was consistent across all major cardiothoracic surgical procedures. Distributions of values of individual predictors varied broadly across predictors over time. Most notable trends were a decrease in elective surgery from 75% to 54% and a rise in patients with no or New York Heart Association I class heart failure from 27% to 33%.CONCLUSIONS: The EuroSCORE II shows good discriminative performance, but consistently overestimates mortality risks of all types of major cardiothoracic surgical procedures in the Netherlands.
KW - Cardiothoracic surgery
KW - Population dynamics
KW - Prediction models
UR - http://www.scopus.com/inward/record.url?scp=85180279676&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ejcts/ezad301
DO - https://doi.org/10.1093/ejcts/ezad301
M3 - Article
C2 - 37672025
SN - 1010-7940
VL - 64
JO - European journal of cardio-thoracic surgery
JF - European journal of cardio-thoracic surgery
IS - 3
M1 - ezad301
ER -