• Zachary O'Brien, Rinaldo Bellomo, Jenni Williams-Spence, Christopher M Reid, and Tim Coulson.
• Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, Victoria, Australia. Electronic address: zach.obrien@monash.edu.
• J. Cardiothorac. Vasc. Anesth. 2024 Feb 1; 38 (2): 430436430-436.

ObjectivesTo optimize the early prediction of prolonged postoperative mechanical ventilation after cardiac surgery (>24 hours postoperatively).DesignThe authors performed a retrospective analysis.SettingThe Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database was utilized.ParticipantsAll patients included in the ANZSCTS database between January 2015 and December 2018 were analyzed.InterventionsNo interventions were performed in this observational study.Measurements And Main ResultsA previously developed model was modified to allow retrospective risk calculation and model assessment (Modified Hessels score). The database was split into development and validation sets. A new risk model was developed using forward and backward stepwise elimination (ANZ-PreVent score). The authors assessed 48,382 patients, of whom 5004 (10.3%) were ventilated mechanically for >24 hours post-operatively. The Modified Hessels score demonstrated good performance in this database, with a c-index of 0.78 (95% CI 0.77-0.78) and a Brier score of 0.08. The newly developed ANZ-PreVent score demonstrated better performance (validation cohort, n = 12,229), with a c-index of 0.84 (95% CI 0.83-0.85) (p < 0.0001) and a Brier score of 0.07. Both scores performed better than the severity of illness scores commonly used to predict outcomes in intensive care.ConclusionsThe authors validated a modified version of an existing prediction score and developed the ANZ-PreVent score, with improved performance for identifying patients at risk of ventilation for >24 hours. The improved score can be used to identify high-risk patients for targeted interventions in future randomized controlled trials.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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