Dynamic trends in cardiac surgery: why the logistic EuroSCORE is no longer suitable for contemporary cardiac surgery and implications for future risk models

Hickey, G. L.; Grant, S. W.; Murphy, G. J.; Bhabra, M.; Pagano, D.; McAllister, K.; Buchan, I.; Bridgewater, B.

doi:10.1093/ejcts/ezs584

Cited by 154Cardiac Valve Diseases and TreatmentsCardiac and Coronary Surgery TechniquesCardiac, Anesthesia and Surgical Outcomes

Dynamic trends in cardiac surgery: why the logistic EuroSCORE is no longer suitable for contemporary cardiac surgery and implications for future risk models

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Hickey, G. L., Grant, S. W., Murphy, G. J., Bhabra, M., Pagano, D., McAllister, K., Buchan, I., Bridgewater, B.·2013·European Journal of Cardio-Thoracic Surgery

DOI 10.1093/ejcts/ezs584PMC PMC3655624

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Abstract

OBJECTIVES: Progressive loss of calibration of the original EuroSCORE models has necessitated the introduction of the EuroSCORE II model. Poor model calibration has important implications for clinical decision-making and risk adjustment of governance analyses. The objective of this study was to explore the reasons for the calibration drift of the logistic EuroSCORE. METHODS: Data from the Society for Cardiothoracic Surgery in Great Britain and Ireland database were analysed for procedures performed at all National Health Service and some private hospitals in England and Wales between April 2001 and March 2011. The primary outcome was in-hospital mortality. EuroSCORE risk factors, overall model calibration and discrimination were assessed over time. RESULTS: A total of 317 292 procedures were included. Over the study period, mean age at surgery increased from 64.6 to 67.2 years. The proportion of procedures that were isolated coronary artery bypass grafts decreased from 67.5 to 51.2%. In-hospital mortality fell from 4.1 to 2.8%, but the mean logistic EuroSCORE increased from 5.6 to 7.6%. The logistic EuroSCORE remained a good discriminant throughout the study period (area under the receiver-operating characteristic curve between 0.79 and 0.85), but calibration (observed-to-expected mortality ratio) fell from 0.76 to 0.37. Inadequate adjustment for decreasing baseline risk affected calibration considerably. DISCUSSIONS: Patient risk factors and case-mix in adult cardiac surgery change dynamically over time. Models like the EuroSCORE that are developed using a 'snapshot' of data in time do not account for this and can subsequently lose calibration. It is therefore important to regularly revalidate clinical prediction models.

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Data drift can cause models' performance to deteriorate or behave in unexpected ways.
“Data drift, defined as the systematic shift in the underlying distribution of input features 11 , can cause models' performance to deteriorate [11][12][13] or behave in unexpected ways, which can pose a threat to the safety of patients.”
From Empirical data drift detection experiments on real-world medical imaging data (2024) · cites this paper as [12]

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Dynamic trends in cardiac surgery require dynamic models
Takkenberg, J. J. M. (2016)
Editorial Comment: Dynamic trends in cardiac surgery require dynamic models
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Performance of the EuroSCORE Models in Emergency Cardiac Surgery
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Self-citation

Authors: Hickey, G. L., Grant, S. W., Murphy, G. J., Bhabra, M., Pagano, D., McAllister, K., Buchan, I., & Bridgewater, B.
Affiliations: Manchester Academic Health Science Centre (GB)
Bristol Royal Infirmary (GB)
New Cross Hospital (GB)
University Hospitals Birmingham NHS Foundation Trust (GB)
Corresponding author: Bridgewater, B.
ORCID: Hickey, G. L.
Grant, S. W.
Murphy, G. J.
Pagano, D.
McAllister, K.
Buchan, I.
Venue: European Journal of Cardio-Thoracic Surgery
Publisher: Oxford University Press (OUP)
Published: 2012-11-14
Volume: 43
Issue: 6
Pages: 1146-1152
ISSN: 1010-7940 (ISSN-L)
1873-734X
DOI: 10.1093/ejcts/ezs584
PMC: PMC3655624
OpenAlex: W2164862771
Cited by: 154
References: 23
Citations by year: 2026: 8 · 2025: 8 · 2024: 11 · 2023: 14 · 2022: 11 · 2021: 18 · 2020: 11 · 2019: 6 · 2018: 10 · 2017: 9 · 2016: 10 · 2015: 14 · 2014: 11 · 2013: 12 · 2012: 1
FWCI: 7.82
Type: journal article
Language: en
Open access: green
europepmc.org
Locations: European Journal of Cardio-Thoracic Surgery (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Research Explorer (The University of Manchester) (submittedVersion)
Funders: Medical Research Council (MR/K006665/1, MC_PC_13042)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords: logistic EuroSCORE, EuroSCORE II, in-hospital mortality, coronary artery bypass grafting, risk adjustment
MeSH terms: Calibration, Europe, Cardiac Surgical Procedures, Humans, Prospective Studies, Risk, Reproducibility of Results, Models, Statistical, Logistic Models, Risk Assessment

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Dynamic trends in cardiac surgery: why the logistic EuroSCORE is no longer suitable for contemporary cardiac surgery and implications for future risk models

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