Preoperative risk assessment tools for morbidity after cardiac surgery: a systematic review.
Cardiac surgery
Morbidity outcome
Postoperative morbidity
Preoperative risk
Risk prediction models
Journal
European journal of cardiovascular nursing
ISSN: 1873-1953
Titre abrégé: Eur J Cardiovasc Nurs
Pays: England
ID NLM: 101128793
Informations de publication
Date de publication:
14 10 2022
14 10 2022
Historique:
received:
01
09
2021
revised:
20
12
2021
accepted:
11
01
2022
pubmed:
17
2
2022
medline:
19
10
2022
entrez:
16
2
2022
Statut:
ppublish
Résumé
Postoperative morbidity places considerable burden on health and resources. Thus, strategies to identify, predict, and reduce postoperative morbidity are needed. To identify and explore existing preoperative risk assessment tools for morbidity after cardiac surgery. Electronic databases (including MEDLINE, CINAHL, and Embase) were searched to December 2020 for preoperative risk assessment models for morbidity after adult cardiac surgery. Models exploring one isolated postoperative morbidity and those in patients having heart transplantation or congenital surgery were excluded. Data extraction and quality assessments were undertaken by two authors. From 2251 identified papers, 22 models were found. The majority (54.5%) were developed in the USA or Canada, defined morbidity outcome within the in-hospital period (90.9%), and focused on major morbidity. Considerable variation in morbidity definition was identified, with morbidity incidence between 4.3% and 52%. The majority (45.5%) defined morbidity and mortality separately but combined them to develop one model, while seven studies (33.3%) constructed a morbidity-specific model. Models contained between 5 and 50 variables. Commonly included variables were age, emergency surgery, left ventricular dysfunction, and reoperation/previous cardiac surgery, although definition differences across studies were observed. All models demonstrated at least reasonable discriminatory power [area under the receiver operating curve (0.61-0.82)]. Despite the methodological heterogeneity across models, all demonstrated at least reasonable discriminatory power and could be implemented depending on local preferences. Future strategies to identify, predict, and reduce morbidity after cardiac surgery should consider the ageing population and those with minor and/or multiple complex morbidities.
Sections du résumé
BACKGROUND
Postoperative morbidity places considerable burden on health and resources. Thus, strategies to identify, predict, and reduce postoperative morbidity are needed.
AIMS
To identify and explore existing preoperative risk assessment tools for morbidity after cardiac surgery.
METHODS
Electronic databases (including MEDLINE, CINAHL, and Embase) were searched to December 2020 for preoperative risk assessment models for morbidity after adult cardiac surgery. Models exploring one isolated postoperative morbidity and those in patients having heart transplantation or congenital surgery were excluded. Data extraction and quality assessments were undertaken by two authors.
RESULTS
From 2251 identified papers, 22 models were found. The majority (54.5%) were developed in the USA or Canada, defined morbidity outcome within the in-hospital period (90.9%), and focused on major morbidity. Considerable variation in morbidity definition was identified, with morbidity incidence between 4.3% and 52%. The majority (45.5%) defined morbidity and mortality separately but combined them to develop one model, while seven studies (33.3%) constructed a morbidity-specific model. Models contained between 5 and 50 variables. Commonly included variables were age, emergency surgery, left ventricular dysfunction, and reoperation/previous cardiac surgery, although definition differences across studies were observed. All models demonstrated at least reasonable discriminatory power [area under the receiver operating curve (0.61-0.82)].
CONCLUSION
Despite the methodological heterogeneity across models, all demonstrated at least reasonable discriminatory power and could be implemented depending on local preferences. Future strategies to identify, predict, and reduce morbidity after cardiac surgery should consider the ageing population and those with minor and/or multiple complex morbidities.
Identifiants
pubmed: 35171231
pii: 6529442
doi: 10.1093/eurjcn/zvac003
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
655-664Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
Déclaration de conflit d'intérêts
Conflict of interest: The author(s) declare there are no conflict of interest.