Arshad, Ahmad Wafi Mohd
(2020)
Retrospective study on prediction of mortality outcome Using post cardiac surgery prognostic scale (pocas) Among patient underwent cardiac surgery at Hospital Universiti Sains Malaysia Kelantan.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Background: Demand for cardiothoracic surgery is increasing in recent decades from better
health service improvement throughout the world resulting in higher life expectancies and
better health care coverage. We study association between outcome of 90 days mortality post
cardiac surgery in Cardiothoracic Unit, HUSM and prognostic scale; Post- operative Cardiac
Surgery Score (POCAS) and EuroSCORE II in order to improve post-operative care of cardiac
surgery patient in our center.
Methods: This is a retrospective record review study of adult patient who underwent cardiac
surgery in Cardiothoracic Unit, Hospital Universiti Sains Malaysia, Kelantan from 1st January
2012 until 31st December 2018. Data was collected from medical records and post-operation
registration database. Cardiac surgery included are isolated coronary artery bypass surgery
(CABG), valve replacement or repair surgery, combined operation of CABG and valve surgery
and congenital heart septal closure surgery.
Results: A total of 158 patients who underwent cardiac surgery were included in this study. We
found 133 survivors and 25 cases of mortality within 90 days after cardiac surgery throughout
the period of study. Based on POCAS score, we found there is association of this scale with
mortality cases. By regression analysis, we found that when there is an increase of 1 score of
POCAS, there is 1.286 times increment of odds for 90 days post-operative mortality (AOR;
1.286, 95% CI; 1.172 – 1.410, p =<0.001). Furthermore, we study on regression analysis and
found there is significant association as well between mortality cases with EuroSCORE II
scale. When adjusted for 90 days post-operative mortality, we found that with an increase of 1
score of EuroSCORE II scale, patient has 2.875 times the odds to have mortality 90 days post
cardiac surgery in HUSM population (AOR 2.875, 95% CI; 1.923 – 4.298, p =<0.001).
Conclusion: There is significant association between POCAS score which is post-operative
biochemical and hemodynamics parameters scale with 90 days post-operative mortality. There
is significant association between mortality prediction of EuroSCORE II and mortality
observed cases as well. Prediction of mortality after cardiac surgery may enlighten clinicians
to lay down strategy of intensive care in complex cardiac surgery cases.
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