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The development of a postoperative morbidity score to assess total morbidity burden after cardiac surgery.

Sanders, J; Keogh, BE; Van der Meulen, J; Browne, JP; Treasure, T; Mythen, MG; Montgomery, HE; (2012) The development of a postoperative morbidity score to assess total morbidity burden after cardiac surgery. J Clin Epidemiol , 65 (4) pp. 423-433. 10.1016/j.jclinepi.2011.11.004.

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Abstract

OBJECTIVE: To develop a tool for identifying and quantifying morbidity following cardiac surgery (cardiac postoperative morbidity score [C-POMS]). STUDY DESIGN AND SETTING: Morbidity was prospectively assessed in 450 cardiac surgery patients on postoperative days 1, 3, 5, 8, and 15 using POMS criteria (nine postoperative morbidity domains in general surgical patients) and cardiac-specific variables (from expert panel). Other morbidities were noted as free text and included if prevalence was more than 5%, missingness less than 5%, and mean expert-rated severity-importance index score more than 8. Construct validity was assessed by expert panel review, Cronbach's alpha (internal consistency), and linear regression (predictive ability of C-POMS for length of stay [LOS]). RESULTS: A 13-domain model was derived. Internal consistency (>0.7) on D3-D15 permits use as a summative score of total morbidity burden. Mean C-POMS scores were 3.4 (D3), 2.6 (D5), 3.4 (D8), and 3.8 (D15). Patient LOS was 4.6 days (P=0.012), 5.3 days (P=0.001), and 7.6 days (P=0.135) longer in patients with C-POMS-defined morbidity on D3, D5, D8, and D15, respectively, than in those without. For every unit increase in C-POMS summary score, subsequent LOS increased by 1.7 (D3), 2.2 (D5), 4.5 (D8), and 6.2 (D15) days (all P=0.000). CONCLUSION: C-POMS is the first validated tool for identifying total morbidity burden after cardiac surgery. However, further external validation is warranted.

Type: Article
Title: The development of a postoperative morbidity score to assess total morbidity burden after cardiac surgery.
Location: United States
DOI: 10.1016/j.jclinepi.2011.11.004
Keywords: Aged, Algorithms, Cardiac Surgical Procedures, Clinical Trials as Topic, Female, Great Britain, Heart Diseases, Humans, Male, Middle Aged, Postoperative Care, Postoperative Complications, Preoperative Care, Prevalence, Prospective Studies, Reproducibility of Results, Risk Assessment
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of)
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of) > Internal Medicine
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Child Health
UCL > School of BEAMS > Faculty of Maths and Physical Sciences
UCL > School of BEAMS > Faculty of Maths and Physical Sciences > Mathematics
URI: http://discovery.ucl.ac.uk/id/eprint/1343096
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