Retuning mortality risk prediction in paediatric cardiac surgery: The additional role of early postoperative metabolic and respiratory profile

Marco Ranucci, Valeria Pistuddi, Giulia Pinuccia Pisani, Concetta Carlucci, Giuseppe Isgrò, Alessandro Frigiola, Giuseppe Pomè, Alessandro Giamberti

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: The existing risk stratification scores for paediatric patients undergoing cardiac surgery include the Aristotle Basic Complexity (ABC) Score, the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) Score and the Aristotle Comprehensive Complexity (ACC) Score. They are all based on the nature of the surgical operation (ABC and RACHS-1 Scores) with possible adjustment for a number of patient conditions (ACC Score). The present study investigates if the early postoperative parameters may be used to improve the preoperative mortality risk prediction. METHODS: A retrospective study on 1392 consecutive patients aged ≤12 years old, undergoing cardiac surgery with cardiopulmonary bypass and without a residual right-to-left shunt was conducted. The ABC Score and metabolic and respiratory postoperative parameters at arrival in the intensive care unit were tested for association and discriminative power for operative mortality. RESULTS: The ABC yielded a c-statistic of 0.746. Additional independent predictors of operative mortality were postoperative hypoxia (PaO2/FIO2<200) and arterial blood lactates. In a multivariable model including the ABC Score, postoperative hypoxia and arterial blood lactates remained independently associated with operative mortality. A modified ABC Score was created, consisting of the ABC Score plus 1.5 points in case of postoperative hypoxia plus 1 point per each 1 mmol/l of arterial blood lactates. The new model was significantly (P = 0.043) more discriminative than the ABC Score, with a c-statistic of 0.803. CONCLUSIONS: Early postoperative respiratory and metabolic parameters increased the accuracy and discrimination of the ABC Score. An external validation is needed to confirm our results.

Original languageEnglish
Pages (from-to)642-649
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume50
Issue number4
DOIs
Publication statusPublished - Oct 1 2016

Keywords

  • Congenital heart surgery
  • Operative mortality
  • Risk stratification

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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