What is the purpose of the Euroscore (European System for Cardiac Operative Risk Evaluation) 2 in cardiac surgery?

The Purpose of EuroSCORE II in Cardiac Surgery

EuroSCORE II is a risk stratification tool used in cardiac surgery to predict perioperative mortality, helping clinicians adjust available resources to predicted outcomes and inform decision-making for surgical interventions. 1

How EuroSCORE II Works

EuroSCORE II calculates operative risk based on multiple patient-specific factors:

• Patient factors: Age, sex, renal function, extracardiac arteriopathy, mobility status
• Cardiac factors: LVEF, pulmonary hypertension, previous cardiac surgery
• Operative factors: Urgency, procedure complexity, surgery on thoracic aorta

The score generates a percentage risk of mortality that helps guide clinical decision-making and resource allocation.

Clinical Applications of EuroSCORE II

1. Preoperative Risk Assessment

• Identifies high-risk patients who may need additional optimization
• Helps determine if a patient is a suitable candidate for surgery
• Supports informed consent discussions with patients 1, 2

2. Resource Allocation

• Allows hospitals to allocate appropriate resources based on predicted risk
• Helps plan postoperative care requirements (ICU beds, monitoring needs)
• Guides staffing decisions for complex cases 1

3. Quality Assurance

• Enables benchmarking of surgical outcomes against predicted mortality
• Allows comparison between different surgical centers
• Helps identify areas for improvement in surgical care 1

4. Heart Team Decision-Making

• Facilitates multidisciplinary discussions about optimal treatment strategies
• Helps determine whether surgical (CABG) or percutaneous revascularization is most appropriate
• Supports the Heart Team approach involving cardiologists and cardiac surgeons 2

Limitations and Considerations

Accuracy Concerns

• EuroSCORE II slightly overestimates perioperative risk in elderly patients (>80 years) 1
• Recent studies suggest it may not be reliable for high-risk patients, underestimating mortality in emergency settings with EuroSCORE II values above 10 3
• For elective surgeries, very low EuroSCORE II values may overestimate the observed mortality 3

Comparison with Other Risk Scores

• The Society of Thoracic Surgeons (STS) risk score is preferred in the United States and may have better discrimination for CABG patients 2, 4
• EuroSCORE II has better predictive discrimination for operative mortality than the original EuroSCORE I, which greatly overestimated risk 4, 5
• EuroSCORE II shows optimal calibration until 30%-predicted mortality but doesn't significantly improve performance in higher-risk patients 6, 7

Additional Risk Assessment

• B-type natriuretic peptide (BNP) levels before surgery provide additional risk stratification 1
• EuroSCORE II has limited ability to assess certain risk factors such as frailty, liver cirrhosis, and malnutrition 2

Best Practices for Using EuroSCORE II

1. Calculate EuroSCORE II for all cardiac surgery patients
2. Use results to guide preoperative optimization strategies
3. Discuss predicted risks with patients as part of informed consent
4. Consider additional risk assessment tools for high-risk patients
5. Interpret results in context of clinical judgment and patient preferences
6. Use for quality improvement by comparing observed vs. expected mortality

Pitfalls to Avoid

• Don't rely solely on EuroSCORE II for high-risk patients - Consider additional risk assessment tools 7
• Don't ignore clinical judgment - The score should inform but not replace clinical decision-making
• Don't use outdated versions - EuroSCORE II is more accurate than the original EuroSCORE 5
• Don't overlook procedure-specific risks - EuroSCORE II is a general cardiac surgery risk model and may not capture all risks for specific procedures

EuroSCORE II remains a valuable tool for predicting mortality risk in cardiac surgery patients, though clinicians should be aware of its limitations, particularly in high-risk populations, and use it as part of a comprehensive evaluation process.