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Ann Thorac Surg 2006;82:2078-2079
© 2006 The Society of Thoracic Surgeons
Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, 110 Irving St NW, Room 1F-1207, Washington, DC 20010-2975
(Email: emmanouil.kapetanakis{at}medstar.net).
The currently available perioperative mortality and morbidity risk assessment tools, such as Parsonnet’s score and Euroscore, are exclusively based on patients’ preoperative comorbidities. In contrast, there exists no validated model to identify and assess postcardiac surgery patients’ mortality risk at the intensive care unit (ICU) bedside. Such a tool would be useful for clinicians so as to estimate each patient’s day-to-day risk status and divert ICU resources and attention to sicker patients.
In this study, Pätilä and colleagues [1] suggest that the Sequential Organ Failure Assessment (SOFA) scoring system be used as a mortality risk estimation tool in postoperative cardiac surgery patients. Their reasoning was that SOFA scores are a straightforward, reliable way of measuring the degree of multiorgan failure on a daily basis. To corroborate their assertion, the authors calculated concomitant Euroscore values and compared them with SOFA scores. The SOFA score’s simplicity and ability of continuous assessment make it a preferred choice over other ICU prediction scores such as the Acute Physiology And Chronic Health Evaluation (APACHE) score, which provides only an admission risk factor profile.
Although SOFA scoring was not designed to be applied to cardiac surgery patients, such use has been previously reported in the literature. This study further adds to the limited evidence available. Based on their observed correlation between SOFA scores and mortality, the authors conclude that their study further supports the applicability of SOFA scoring in adult cardiac surgery patients.
However, SOFA scoring is probably not the risk assessment tool we seek. It is too crude a device, not actually designed de novo to be applied to postoperative cardiac surgery patients. It is limited in accurately evaluating cardiovascular function, renal function, and neurologic status in those patients. It is not therefore surprising that the authors found that the predictive power of SOFA scoring for mortality was not as good as the Euroscore. In truth what is really needed is a more focused assessment tool, possibly something similar to the Cardiac Surgery Score (CASUS) or the CASUS score itself.
As the authors point out, this is a single institution study with a rather small cohort, low number of index events (mortality), and diverse surgical range. Therefore, it cannot by itself validate and authoritatively establish postoperative SOFA score use in cardiac surgery patients. However, this article, despite not providing the definitive answer to the question, raises awareness on the issue at hand; the need for a focused ICU assessment tool in cardiac surgery. I do not believe this is going to be provided by SOFA scoring, but I look forward to continued efforts in this area by Pätilä and colleagues [1] and others.
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