Ann Thorac Surg 2006;82:1950
© 2006 The Society of Thoracic Surgeons
Correspondence
Simplified Risk Stratification System for Open Heart Surgery
Victor Parsonnet, MD
Division of Surgical Research, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112
(Email: vpacel{at}earthlink.net).
To the Editor:
We refer to the commentary by Edwards on the article by Berman and colleagues [1].
Our original scoring system had two goals: (1) to compare results of one institution with another to correct for case mix severity, and (2) to predict the chance of death in any individual. Then the late 1980s operative mortality rates for routine open heart surgery were high, but today rarely exceed 1%. Competition for area-wide recognition has abated, and the need for fairly precise risk stratification has decreased.
Doctor Edwards was critical of our simplified method because handheld personal digital assistants (PDAs) can be used more easily than paper and pencil. When we conceived this method, PDAs were not ubiquitous, but now that would be our approach.
Even simpler, just the number of risk factors in the individual patient correlated well with the outcome (unpublished data—see Fig 1). These data were derived from 16,246 coronary bypass procedures in New Jersey in 1996–1997 versus the same patient cohort with risk-adjusted rates as calculated by the New Jersey Department of Health and Senior Services (dark bars) used at that time.
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Fig 1. Observed mortality rates (clear bars) for 16,246 isolated aortocoronary-bypass procedures performed during 1996 and 1997 at 13 New Jersey hospitals, with 95% binomial confidence limits superimposed. Included for comparison are risk-adjusted mortality-rate estimates (dark bars) for the same procedures as calculated from a 9-factor logistic-regression model published by the New Jersey Department of Health and Senior Services (NJDOHSS).
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We agree with the authors that the simplicity of our method has much to offer, because it requires so little data entry, especially when it is used for bedside use. It is comforting to find that others agree.
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References
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- Berman M, Stamler A, Sahar G, et al. Validation of the 2000 Bernstein–Parsonnet score versus the EuroSCORE as a prognostic tool in cardiac surgery Ann Thorac Surg 2006;81:537-541.[Abstract/Free Full Text]
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