Vojvodinascore - local system for cardiac operative risk evaluation

Introduction. The aim of the study was to investigate the prognostic value, sensitivity and specificity of both the logistic and additive European System for Cardiac Operative Risk Evaluation (as well as the European System for Cardiac Operative Risk Evaluation II and to assess the necessity for developing a local outcome prediction model in cardiac surgery. Material and Methods. The research included 406 consecutive patients who had undergone cardiac surgical procedures at Institute of Cardiovascular Diseases of Vojvodina from January 2012 to July 2012. The authors compared the predicted mortality according to the additive and logistic European Systems for Cardiac Operative Risk Evaluation, the new European System for Cardiac Operative Risk Evaluation II and the observed mortality (30 days after surgery). Results. The difference between the predicted and observed mortality regarding the whole group of 406 operated cardiac patients was not statistically significant for the additive European System for Cardiac Operative Risk Evaluation (p=0.081) and the European System for Cardiac Operative Risk Evaluation II (p=0.164), but it was statistically significant for the logistic European System for Cardiac Operative Risk Evaluation (p=0.031). The areas under the receiver operating characteristic curves are statistically different from 0.5 for both models (additive and logistic European System for Cardiac Operative Risk Evaluation), as well as for the European System for Cardiac Operative Risk Evaluation II. However, the proper classification of the patients has not been observed since their sensitivity and specificity are not satisfactory. Conclusion. The additive and logistic European Systems for Cardiac Operative Risk Evaluation overestimate while the European System for Cardiac Operative Risk Evaluation II underestimates the risk in cardiac surgery. We believe that a locally derived model would be of great use in the everyday clinical practice since it would faithfully illustrate the actual state of patient population of the region where it was developed. At the same time it would provide the accurate prediction of surgical outcome.