Heart 2000;84:71-78 ( July )

Interventional cardiology surgery

Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England K Wynne-Jones^a, M Jackson^b, G Grotte^c, B Bridgewater^a, on behalf of the North West Regional Cardiac Surgery Audit Steering Group

^a Departments of Cardiothoracic Surgery and Clinical Audit, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK, ^b Departments of Cardiothoracic Surgery and Clinical Audit, The Cardiothoracic Centre-Liverpool, Thomas Drive, Liverpool L14 3PE, UK, ^c Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK

Correspondence to: Dr Bridgewater email: ben{at}bridgewaterb.fsnet.co.uk

Accepted 8 February 2000

OBJECTIVETo study the use of the Parsonnet score to predict mortality following adult cardiac surgery.
DESIGNProspective study.
SETTINGAll centres performing adult cardiac surgery in the north west of England.
SUBJECTS8210 patients undergoing surgery between April 1997 and March 1999.
MAIN OUTCOME MEASURESRisk factors and in-hospital mortality were recorded according to agreed definitions. Ten per cent of cases from each centre were selected at random for validation. A Parsonnet score was derived for each patient and its predictive ability was studied.
RESULTSData collection was complete. The operative mortality was 3.5% (95% confidence interval 3.1% to 3.9%), ranging from 2.7% to 3.8% across the centres. On validation, the incidence of discrepancies ranged from 0% to 13% for the different risk factors. The predictive ability of the Parsonnet score measured by area under the receiver operating characteristic curve was 0.74. The mean Parsonnet score for the region was 7.0, giving an observed to expected mortality ratio of 0.51 (range 0.4 to 0.64 across the centres). A new predictive model was derived from the data by multivariate analysis which includes nine objective risk factors, all with a significant association with mortality, which highlights some of the deficits of the Parsonnet score.
CONCLUSIONSRisk stratified mortality data were collected on 100% of patients undergoing adult cardiac surgery in two years within a defined geographical region and were used to set an audit standard. Problems with the Parsonnet score of subjectivity, inclusion of many items not associated with mortality, and the overprediction of mortality have been highlighted.


Keywords: risk stratification; cardiac surgery; Parsonnet score; audit

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© 2000 by Heart
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