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J Thorac Cardiovasc Surg 2008;136:7-9
© 2008 The American Association for Thoracic Surgery

Editorial

The future of risk stratification in thoracic surgery

Ioannis K. Toumpoulis, MDa,*, Chris K. Rokkas, MDb, Themistocles P. Chamogeorgakis, MDb

a Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
b Department of Cardiothoracic Surgery, Attikon Hospital Center, University of Athens Medical School, Athens, Greece

Received for publication March 2, 2008; accepted for publication March 12, 2008.

* Address for reprints: Ioannis K. Toumpoulis, MD, Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 77 Ave Louis Pasteur, Room 144, Boston, MA 02115. (Email: toumpoul@otenet.gr).

The first 300 words of the full text of this article appear below.

Risk stratification plays an important role in surgical specialties worldwide. Multivariable models are used to assess the clinical outcomes in an objective risk-adjusted manner and allow useful comparisons to be made between countries, regions, hospitals, and individual surgeons. The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database in the United States has been one of the biggest and most reliable risk-adjusted databases, and it is the gold standard for clinical data analysis in the field of cardiac surgery. Similarly, the open source algorithm of the European System for Cardiac Operative Risk Evaluation (EuroSCORE), which was developed in Europe, represents another reliable, widely established and validated model for risk stratification in the entire context of cardiac surgery.

During the past 15 years, while STS and EuroSCORE algorithms were developed, thoracic surgery is lacking an accepted general model for in-hospital mortality. Recently, Thoracoscore became available, and it is the first multivariate model for the prediction of in-hospital mortality in the entire context of thoracic surgery.1Go Thoracoscore was developed from 15,183 patients who underwent thoracic surgery in 59 French hospitals. In the meanwhile, the corresponding General Thoracic Database of the STS is still under development, accounting for 49,000 patients (1999–2006). However, there is no risk stratification model published to date from this North American database. All the aforementioned indicate that the risk stratification in thoracic surgery is in its birth and early stages. There are many reasons for general thoracic surgeons to help in the progression and the development of risk stratification in thoracic surgery, such as quality improvements in patient care and patient outcomes, differentiation from surgeons who are less qualified to perform thoracic surgery, recertification of surgeons, costs of surgery, and pay for performance.2Go

Thoracoscore is a reliable risk stratification model because it comes from a national electronic prospective database . . . [Full Text of this Article]






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