Does EuroSCORE work in individual European countries?

Objective: Because of national epidemiological differences in adult heart s urgery in Europe, the effectiveness and desirability of a pan-European scor e for the assessment of quality of surgical care remains controversial. We assessed the predictive value of EuroSCORE in national subsets of the EuroS CORE database. Methods: The EuroSCORE development data set was divided into national subsets of which those with 500 or more patients were selected fo r analysis. The Hosmer-Lemeshow goodness-of-fit test was applied to assess the calibration of the EuroSCORE model on individual national samples and t he areas under the receiver operating characteristic (ROC) curve were measu red to analyse the EuroSCORE discriminative power on individual death predi ction. Results: There were 18 676 patients in the six largest national samp les: Germany, United Kingdom, Spain, Finland, France and Italy (mean: 3113 patients; range: Finland 1266 to France 4507). Major differences were obser ved in national distribution of procedures: coronary artery bypass grafting accounted for 77.7% of procedures in Finland but only 46.2% in Spain. The EuroSCORE model goodness-of-fit was satisfactory in all countries (P-value overall: 0.4; UK: 0.34; Finland: 0.87; no values less than 0.05). Areas und er ROC curves were 0.81 in Germany, 0.79 in the UK, 0.74 in Spain, 0.87 in Finland, 0.82 in France and 0.82 in Italy. Conclusion: Despite epidemiologi cal differences between European countries, the discriminative power of Eur oSCORE was good in Spain and excellent in all other countries. The system, developed from a merged European database, can therefore be used to assess improvement in quality of care achieved by surgeons and institutions as wel l as for international European comparison in adult heart surgery. (C) 2000 Elsevier Science B.V. All rights reserved.