Sevinç BAYER ERDOĞAN, Murat BAŞTOPCU, Hüseyin KUPLAY, Eren KARPUZOĞLU, Halit ER

EuroSCORE II ve STS skorlarının 80 yaş ve üzeri kalp cerrahisi hastalarında performansı

Amaç: Bu çalışmada Göğüs Cerrahisi Derneği (STS) ve Avrupa Kardiyak Operatif Risk Değerlendirme Sistemi II (EuroSCORE II) skorlarının 80 yaş ve üzeri kalp cerrahisi hastalarında mortalite için öngördürücü değeri araştırıldı. Çalışma planı: Ocak 2016 - Aralık 2019 tarihleri arasında 80 yaş ve üzeri 116 hastada (73 erkek, 43 kadın; ort. yaş: 82.9±3.1 yıl; dağılım, 80-97 yıl) gerçekleştirilen kalp ameliyatları retrospektif olarak incelendi. Mortalite görülen ve görülmeyen hastalar demografik ve cerrahi faktörler açısından karşılaştırıldı. STS, EuroSCORE II skorları ve gözlenen mortalite oranları karşılaştırıldı. Bulgular: Ortalama STS skoru 3.7±11.1 ve ortalama EuroSCORE II 5.2±5.4 idi. Tüm cerrahi türlerinde, ortalama EuroSCORE II mortalite gözlenen hastalarda daha yüksekti (sırasıyla, 4.1±4.0’e kıyasla 8.1±7.4; p=0.006). Elektif cerrahilerde ortalama EuroSCORE II mortalite görülen olgularda daha yüksekti (sırasıyla, 3.7±3.9’a kıyasla 7.2±7.3; p=0.006); ancak, acil olgularda skorlar arasında bir fark gözlenmedi. Alıcı işletim karakteristik eğrisi ile STS skorlarına kıyasla, EuroSCORE II’nin eğri altında kalan alanı tüm olgularda ve elektif olgularda daha yüksekti. Sonuç: EuroSCORE II 80 yaş ve üzeri hastalarda STS skoruna kıyasla mortaliteyi öngörmede daha iyi bir performans gösterirken, acil cerrahiler ve kombine işlemlerde iki skorlama sisteminin öngördürücülüğü yetersizdi. Bu yaş grubunda daha iyi bir risk skorlama sistemi için toplum tabanlı validasyon çalışmalarına ihtiyaç vardır.

Performance of the EuroSCORE II and the STS score for cardiac surgery in octogenarians

Background: We aimed to investigate the predictive value of Society of Thoracic Surgeons (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE II) scores for mortality in octogenarian cardiac surgery patients. Methods: Between January 2016 and December 2019, cardiac operations performed in 116 octogenarian patients (73 males, 43 females; mean age: 82.9±3.1 years; range, 80 to 97 years) were retrospectively analyzed. The patients with and without mortality were compared for their demographic and operative factors. The STS and EuroSCORE II scores, and observed mortality rates were assessed. Results: Mean STS score was 3.7±11.1 and mean EuroSCORE II was 5.2±5.4. For any operation type, the mean EuroSCORE II was significantly higher (8.1±7.4 vs. 4.1±4.0, respectively; p=0.006) in the patients with mortality. For elective operations, the mean EuroSCORE II was higher in cases with mortality (7.2±7.3 vs. 3.7±3.9, respectively; p=0.006); however, for urgent cases, there was no significant difference between the scores. Using the receiver operating characteristic curve, the EuroSCORE II had a higher area under the curve for all cases and elective cases than the STS scores. Conclusion: The EuroSCORE II performed better than the STS score for mortality prediction in octogenarians, whereas the predictions of either scoring system was unsatisfactory for urgent surgery and combined procedures. Population-based validation studies are needed for a better risk scoring system in this age group.

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