# The Role of EuroSCORE II in Predicting Postoperative Pressure Injuries in Cardiac Surgery Patients: A Cross-Sectional Study

## TL;DR

This study shows that the EuroSCORE II index can predict pressure injuries after cardiac surgery, with higher scores linked to increased risk.

## Contribution

The study demonstrates that EuroSCORE II can improve postoperative pressure injury risk assessment in cardiac surgery patients.

## Key findings

- Patients with a EuroSCORE II >4% had a 30.8% incidence of pressure injuries compared to 17.6% in lower-risk groups.
- Higher EuroSCORE II scores correlate with older age, longer surgery times, and longer hospital stays.
- The EuroSCORE II outperformed the Braden Scale in predicting pressure injury risk in cardiac surgery patients.

## Abstract

Patients with a medium/high EuroSCORE II index (>4%) had a significantly higher incidence of postoperative pressure injuries (PI), which suggests that EuroSCORE II can help identify patients at elevated risk of PIs following cardiac surgery.

Higher EuroSCORE II index values are linked to poorer clinical outcomes. Patients with higher index values are older, have longer operative time, longer ICU and hospital stays, and lower ejection fraction. These factors are commonly associated with increased PI vulnerability.

Conventional assessment tools such as the Braden Scale demonstrated limited effectiveness in accurately predicting PI risk in cardiac surgery patients. The findings suggest that incorporating EuroSCORE II into risk evaluation may enhance assessment accuracy, particularly in cardiac surgery contexts where both procedure-related and individual patient factors play a significant role.

Background/Objectives: Pressure injuries (PIs) are an increasing public health concern, particularly affecting hospitalised patients with limited mobility and chronic illnesses, such as those undergoing cardiac surgery. The EuroSCORE II index, a validated model for predicting operative risk in cardiac surgery, can serve as an accurate PI risk assessment tool for cardiac surgery patients. Methods: A cross-sectional study was conducted on patients undergoing cardiac surgery over a six-month period. The sample consisted of patients selected according to the calculated EuroSCORE II index and admitted for elective surgical procedures. The Braden Scale was used for the standard preoperative and postoperative PI risk assessment. Categorical variables are shown as frequencies with corresponding percentages. Continuous variables are presented as median and interquartile range. Group differences in continuous variables according to EuroSCORE II were analysed using the Mann–Whitney U test, with the Hodges–Lehmann estimator of the median difference and the corresponding 95% confidence interval. Results: The assessment showed that patients with a medium and high EuroSCORE II index (>4.0) were significantly older (M = 73; IQR: 68–77), with a higher preoperative Braden score (M = 20; IQR: 17–21), longer intraoperative total time (M = 6; IQR: 5–7) and overall longer duration of hospitalisation (M = 14; IQR: 10–21). A statistically significant difference (p = 0.043) was observed in the occurrence of PI after the procedure. Within the group of patients with a medium/high EuroSCORE II index, the recorded frequency of PI after the procedure was 30.8%, compared to the group of patients with a low EuroSCORE II index, among whom the observed frequency was 17.6%. Conclusions: The findings of this study show that a higher EuroSCORE II index is significantly associated with an increased risk and incidence of PI in patients undergoing cardiac surgery, highlighting its potential use as a predictive tool for postoperative PI risk stratification.