System 97

(Predictive score for acquired adult heart surgery )

Preoperative risk factors
Logistic regression model

Bedside approximation score

eValue : 1 if yes, 0 otherwise

Beta

e

Age

< 70 70-74 75-79 > 79

Female gender

Yes No

Diabetes mellitus

Yes No

Congestive heart failure

Yes No

Left mainstem stenosis >= 50 %

Yes No

COPD

Yes No

Pulmonary hypertension

Yes No

Peripheral vascular disease

Yes No

Morbid obesity (> 1.5 ideal weight)

Yes No

Preoperative IABP

Yes No

Aortic valve : replacement

e

Aortic valve : regurgitation (endocarditis)

CABG added to valve surgery

Yes No

Neurologic disorder

Yes No

Hypertension (> 140/90 mmHg)

Yes No

Left ventricular ejection fraction

< 30 % 30-49 % > 50 %

Cardiomegaly

Yes No

Reoperation

Yes, first Yes, secondNo

Neoplasm, active

e

Acute MI within 48 h

Yes No

Renal failure

Yes No

Left ventricular aneurysm to be resected

Yes No

Ventricular tachycardia or fibrillation

Yes No

Mitral : valve replacement

Yes No

Mitral : acute regurgitation

e

Carotid disease

Yes (uni or bilateral) No

Asthma

Yes No

Failed PTCA

Yes No

Substance abuse

Yes No

Cardiogenic shock

Yes No

Pacemaker dependency

e

Cold agglutinins

Abdominal aortic aneurysm present

Yes No

Intubated

Yes No

Dialysis dependency

Yes No

Endocarditis

Treated Active No

Tricuspid valve replacement

Yes No

Cirrhosis

Yes No

Ideopathic, thrombogenic purpura

Yes No

Blood products refused

Yes No

AIDS

Approximation Score =
(Help below)

( Definitions of the risk factors are not available in the referenced paper)

Logit = - 5.1850 + sum (values * beta)
Predicted death rate within 30 days
= 1 / (1 + e-Logit)
Predicted death rate =.

 

Ref : Bernstein AD, Parsonnet V. Bedside estimation of risk as an aid for decision making in cardiac surgery. Ann Thorac Surg. 2000;69:823-8.

  

 Web page by Jean-Yves Marandon Centre Chirurgical Marie Lannelongue (France) 

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Approximation Score : "The logistic regression model described above was simplified to facilitate the rapid approximation of preoperative risk ... All coefficients were rounded to the nearest half-integer and multiplied by 10, and some infrequent risk factors with negative coefficients ( which occur rarely ) were omitted.
Two covariates with negative coefficients were assigned new weights on an empirical basis: refusal of blood products and repair of a ventricular defect were adjudged of equivalent risk to pulmonary hypertension and cardiogenic shock....
These empirical adjustments, based on clinical experience, were made only in low-prevalence covariates whose logistic regression coefficients had large standard errors."

 

 

Use the total score (bedside approximation) to read the estimated preoperative risk range from this plot, which shows the estimated risk of mortality together with 95% confidence limit.

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