ArticleBMJ open2025
Development and validation of a postoperative risk calculator (POP-score) for patients undergoing cardiac surgery: a retrospective cohort study.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aimed to identify intraoperative and perioperative factors influencing 30-day mortality after cardiac surgery and to develop a risk score (POP-score) for its prediction.
designRetrospective cohort study with multivariable regression analysis.
settingA tertiary care cardiac surgery centre in Austria; data from consecutive patients undergoing cardiac surgery between 2010 and 2020 were analysed.
participantsA total of 8072 patients were included. The cohort was randomly divided into a derivation cohort (75%) and a validation cohort (25%). OUTCOME MEASURES: The primary outcome measure was 30-day mortality. We analysed associations between intraoperative and perioperative variables and 30-day mortality, assessed via multivariable regression analysis.
resultsSeveral factors were significantly associated with 30-day mortality, including intraoperative RBC transfusion (OR 3.407 (95% CI 2.124-5.464)), postoperative high-sensitive cardiac troponin T cut-off levels (OR 2.856 (95% CI 1.958 to 4.165)), need for dialysis/haemofiltration (OR 2.958 (95% CI 2.013 to 4.348)) and temporary extracorporeal membrane oxygenation support (OR 5.218 (95% CI 3.329 to 8.179)) (p<0.001 for all). The newly developed POP-score demonstrated superior predictive performance for 30-day mortality compared with the EuroSCORE II alone (area under the ROC curve (AUC) 0.884 vs 0.800, p=0.013), based on peak troponin values assessed within the first 7 postoperative days. As 98% of peak troponin elevations occurred within 72 hours, the POP-score can be calculated at this earlier time point for clinical implementation.
conclusionsThe validated POP-score provides an improved tool for predicting 30-day mortality after cardiac surgery by incorporating intraoperative and perioperative factors alongside the EuroSCORE II. Although model performance was evaluated using 7-day peak troponin data, the score can be calculated within the first 72 hours postoperatively in most patients, supporting its clinical applicability for early decision-making, resource allocation and patient counselling. Further research is warranted to assess its clinical utility in diverse populations.
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