CARDIAC-SURGERY - PREDICTIVE MORTALITY IN DEX AND GRAVITY AND CARE SCORES IN A SERIES OF 243 PATIENTS

Objectives: Medical teams are keenly aware of the need to evaluate hea lth care quality and the cost/benefit ratio. We prospectively applied three proposed indexes, designed for predicting mortality, for evaluat ing disease gravity, and for evaluating health care in intensive care patients, in two populations of patients undergoing heart surgery. Met hods: From January to June 1991, 243 patients (mean age 58.1; 55 femal es, 188 males) underwent coronary bypass surgery (n = 116; mean number of bypasses = 2.94 per patient) or valve replacement (n = 127). The p atients were divided into 3 groups of increasing gravity on the basis of the preoperative presentation (Groups 1, 2 and 3 for Parsonnet's in dex, a specific index for predicting mortality in patients with acquir ed cardiopathies undergoing heart surgery = 0-9, 10-19 and >20 respect ively). A comparison was then performed for each population (bypass su rgery and valve replacement) between the predicted mortality and the A PACHE II index of disease gravity and the OMEGA index of intensive car e. Results: Overall mortality was 3.7% (2.85 % in the bypass populatio n and 4.72% in the valve population). The specific Parsonnet index (PI ) for cardiac surgery gave a good indication of mortality risk (observ ed deaths 0.7% for PI = Group 1; 2.6% for PI = Group 2; 13.1% for PI=G roup 3) and of postoperative morbidity since inotropic support was req uired in 18, 45 and 59% for PI Groups 1, 2 and 3 respectively. For pat ients in the PI Group 3, postoperative care in the intensive care unit lasted >3 days and required ventilatory support for >24 hours. APACHE II and OMEGA did not contribute to evaluating the Parsonnet index.Con clusion: A high risk population undergoing cardiac surgery can be defi ned among patients with a Parsonnet index above 20. Under this thresho ld, the risk of mortality falls to 1.4%.