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首页> 外文期刊>World journal for pediatric & congenital heart surgery >Mortality Following Congenital Heart Surgery in Adults Can Be Predicted Accurately by Combining Expert-Based and Evidence-Based Pediatric Risk Scores
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Mortality Following Congenital Heart Surgery in Adults Can Be Predicted Accurately by Combining Expert-Based and Evidence-Based Pediatric Risk Scores

机译：通过结合基于专家和基于证据的小儿风险评分，可以准确预测成人先天性心脏手术后的死亡率

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Objectives: Currently, there are few specific risk stratification models available to predict mortality following congenital heart surgery in adults. We sought to evaluate whether the predictive power of the common pediatric scores is applicable for adults. In addition, we evaluated a new grown-ups with congenital heart disease (GUCH) score specifically designed for adults undergoing congenital heart surgery. Methods and Results: Data of all consecutive patients aged 18 years or more, who underwent surgery for congenital heart disease (CHD) between 2004 and 2013 at our institution, were collected. We evaluated the Aristotle Basic Complexity (ABC), the Aristotle Comprehensive Complexity (ACC), the Risk Adjustment in Congenital Heart Surgery (RACHS-I), and the Society of Thoracic Surgeons (STS)-European Association for Cardiothoracic Surgery (EACTS) scores. The proposed GUCH score consists of the STS-EACTS score, the procedure-dependent and -independent factors of the ACC score, and age. The discriminatory power of the scores was assessed using the area under the receiver-operating characteristics curve (c-index). A total of 830 operations were evaluated. Hospital mortality was 2.9%. C-indexes were 0.67, 0.80, 0.62, 0.78, and 0.84 for the ABC, ACC, RACHS-1, STS-EACTS, and GUCH mortality scores, respectively. Conclusion: The evidence-based EACTS-STS score outperforms the expert-based ABC score. The expert-based ACC score is superior to the evidence-based EACTS-STS score since comorbidities are considered. Our proposed GUCH score outperforms all other scores since it integrates the advantages of the evidence-based EACTS-STS score for procedures and the expert-based ACC score for comorbidities. Evidence-based scores for adults with CHD should include comorbidities and patient ages.
机译：目的：目前，尚无可用于预测成人先天性心脏手术后死亡率的特定风险分层模型。我们试图评估普通儿科评分的预测能力是否适用于成人。此外，我们评估了专为接受先天性心脏病手术的成年人设计的具有先天性心脏病（GUCH）评分的新成年人。方法和结果：收集了2004年至2013年间在本机构接受过先天性心脏病（CHD）手术的所有18岁以上的连续患者的数据。我们评估了亚里斯多德的基本复杂性（ABC），亚里斯多德的综合复杂性（ACC），先天性心脏手术的风险调整（RACHS-I）和胸外科医师协会（STS）-欧洲心胸外科协会（EACTS）得分。提议的GUCH评分包括STS-EACTS评分，ACC评分的与程序相关和独立的因素以及年龄。使用接收者操作特征曲线（c-index）下的面积评估得分的辨别力。总共评估了830次手术。医院死亡率为2.9％。 ABC，ACC，RACHS-1，STS-EACTS和GUCH死亡率得分的C指数分别为0.67、0.80、0.62、0.78和0.84。结论：基于证据的EACTS-STS评分优于基于专家的ABC评分。由于考虑到合并症，基于专家的ACC评分优于基于证据的EACTS-STS评分。我们建议的GUCH评分优于所有其他评分，因为它综合了基于证据的EACTS-STS评分程序和基于专家的ACC评分合并症的优势。成人冠心病的循证评分应包括合并症和患者年龄。

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