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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
Open accessAbstract
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, 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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Metadata
- 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.
- 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
- 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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