Risk Scores Currently Used in German Heart Surgery[∗]

Background: Risk scores (RS) in heart surgery assess mortality and morbidity and mirror the degree of severity of disease of the patients when presented for surgery. We examined the use and dissemination of RS in Germany. Material and Methods: Our survey included 79 German heart surgery institutes in Fall 1999 and Winter 2000. Results: Four institutes did not respond. Out of 75 (ad 100 %) responders 56 (75 %) institutes did not use RS, 17 (22 %) institutes used one RS method and 2 (3 %) institutes used two RS methods. The most frequently applied RS methods were the Cleveland Clinic Score and the Euro Score (n = 7, each) followed by institution-specific, internally developed RS methods (n = 5), Parsonnet's RS (n = 1) and the RS from the STS database (n = 1). Fourteen institutes used RS for internal quality control. Of these, 2 institutes publish their RS data for external quality control. The patient-related individual procedure risk was used in 6 institutes. Conclusions: A quarter of the German heart surgery institutes use one or more RS methods. The most commonly used were the Cleveland Clinic Score and the Euro Score, followed by internally developed RS methods. RS methods were most frequently used for internal quality control. The degree of the severity of disease of the patients who presented for surgery could only be compared between a small number of institutes using the same RS.

Risk score - Cardiac surgery - Quality management - Quality control

References

• 1 Weightman W, Gibbs N, Sheminant M, Thackray N, Newman M. Risk predictors in coronary artery surgery a comparison of four risk scores.  Med J Aust. 1997;  166 408-411
• 2 Immer F, Habicht J, Nessensohn K. et al . Prospective evaluation of 3 risk stratification scores in cardiac surgery.  Thorac Cardiov Surg. 2000;  48 134-139
• 3 Osswald B, Tochtermann U, Schweiger P. et al . Target, application, and interpretation of scores and alternative methods for risk assessment in cardiac surgery.  Thorac Cardiovasc Surg. 2000;  48 72-78
• 4 Higgins T. Quantifying risk and assessing outcome in cardiac surgery.  J Cardiothorac Vasc Anesth. 1998;  12 330-340
• 5 Williams T, Fanning W, Benton W. et al . What is the marginal cost for marginal risk in cardiac surgery?.  Ann Thorac Surg. 1998;  66 1969-1971
• 6 Turner J, Morgan C, Thakrar B, Pepper J. Difficulties in predicting outcome in cardiac surgery patients.  Cnt care Med. 1995;  23 1843-1850
• 7 Higgins T, Estafanous F, Loop F, Beck G, Blurn J, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bjpass patients.  JAMA. 1992;  267 2344-2348
• 8 Parsonnet V. Risk stratification in cardiac surgery - is it worthwhile?.  J Card Surg. 1995;  10 690-698
• 9 Gabrielle F, Roques F, Michel P. et al . Is the Parsonnet's score a good predictive score of mortality in adult cardiac surgery assessment by a French multicentre study.  Eur J Cardiothorac Surg. 1997;  11 406-414

1 Presented on the 30^th Annual Meeting of Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie in Leipzig, February 18 - 21, 2001.