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factors were compared based on the characteristics
of the operated population, Ivanov
et al. (5) have demonstrated that the
application of a standard model may provide
an inaccurate assessment of the performance
of either Heart Surgery Units or single
heart surgeons.
The evaluation of data available to-day has
certainly proved that the average mortality
risk of patients undergoing heart surgery
has been gradually increasing for at least
In fact, over the last 20 years, patients undergoing
bypass surgery have been older
[Table 3] (average age increased from 58 to
65 years), with lower ejection fraction (a reduction
from 62% to 49%), with more severe
coronary heart disease, and a higher
proportion of patients with left main disea-
20 years. For instance, when the Parsonnet
model was applied to the surgical population
of the Beth Israel Hospital in Newark
(6) [Table 2], it was observed that the average
risk of patients gradually increased
from 6.5 (in 1988) to 9.6 (in 1994), while,
in the population of the National Adult Cardiac
Surgical Database Report (7), it increased
from 5.0 (in 1996) to 6.0 (in 1999), and
at the Cleveland Clinic Foundation (8) from
2.9 (in 1996) to 3.1 (in 1999).
AUTHORS DATA EVENT SURGERY NO. RISK
COLLECTION FACTORS
1) Kennedy (CASS) 1975-78 Death Only CABG 20
2) Parsonnet 1982-87 Death All 15
3) Higgins 1986-88 Death Only CABG 9
+ complic.
4) O’Connor 1987-89 Death Only CABG 8
5) STS 1995 Death Only CABG 28
6) Hannan 1989-1992 Death Only CABG 14
7) Tuman 1990 Death + LOS All 11
+ complic.
8) Tu (Ontario) 1991-93 Death + LOS All 6
+ ICU + OSP.
9) Roques 1993 Death All 8
10) Euroscore 1995 Death All 17
Newark Beth National Adult Cardiac Cleveland Clinic
YEAR Israel Hospital Surgical Database Foundation
(Parsonnet) (Parsonnet) (Higgins)
1988 6.5
1989 6.7
1990 7.1
1991 8.9
1992 9.3
1993 9.6
1994 9.6
1995
1996 5.0 2.9
1997 5.0 3.0
1998 5.5 3.1
1999 6.0 3.1
se (an increase from 7% to 20%). They were
operated in medical emergency conditions
(increasing from 5% to 40%), and
with major associated comorbidities (for instance,
the rate of patients affected by renal
failure increased from 2.5% to 4.2%).
Table 4 shows the relationship between the
P. Pinna Pintor et al.
Risk prediction in heart surgery
Tab. 1
General Characteristics of
ten risk models.
Tab. 2
Mean score of the
mortality risk.
9