• Baki Billah, Molla M Huq, Julian A Smith, Fahim Sufi, Lavinia Tran, Gilbert C Shardey, and Christopher M Reid.
• Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: baki.billah@monash.edu.
• J. Thorac. Cardiovasc. Surg.. 2014 Nov 1;148(5):1850-1855.e2.

ObjectivesTo update the Australian System for Cardiac Operative Risk Evaluation (AusSCORE) model for operative estimation of 30-day mortality risk after isolated coronary artery bypass grafting in the Australian population.MethodsData were collected by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry from 2001 to 2011 in 25 hospitals. A total of 31,250 patients underwent isolated coronary artery bypass grafting and the outcome was 30-day mortality. A total of 2154 (6.9%) patients had 1 or multiple missing values. Missing values were estimated assuming missing completely at random and logistic regression with a generalized estimating equation was used to address within-hospital variance. Bootstrapping methods were used to construct and validate the updated model (AusSCORE II). Also the model was validated on an out-of-creation sample of 4700 patients who underwent bypass surgery in 2012.ResultsThe average age of the patients was 65.6±12.9 years and 78.6% were male. Thirteen variables were selected in the updated model. The bootstrap discrimination and calibration of the AusSCORE II was very good (receiver operating characteristics [ROC], 82.0%; slope calibration, 0.987). The overall observed/AusSCORE II predicted mortality was 1.63% compared with the original AusSCORE predicted mortality of 1.01%. The validation of the AusSCORE II on the out-of-sample data also showed a high performance of the model (ROC, 84.5%; Hosmer-Lemoshow P value, .7654).ConclusionsThe AusSCORE II model provides improved prediction of 30-day mortality and successfully stratifies patient risk. The model will be useful to improve the preoperative consultation regarding risk stratification in terms of 30-day mortality.Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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