الفهرس 
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Abstract
ardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon. Frequently, it is done to treat ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart disease, or treat valvular heart disease created by different causes including endocarditis. It also includes heart transplantation (http: //en.wikipedia. org, 2007).
A wide variety of risk stratification systems have been developed to quantify the risk of cardiac surgery. Generally, the focus has been on mortality; however, more recently models have been developed that allow the preoperative prediction of the incidence of morbidity, including renal failure, infection, prolonged ventilation, and neurologic deficit. Patient and surgical factors that are present preoperatively are assessed for their predictive value for postoperative complications. (Granton, and Cheng, 2008)
European System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed across 128 centers in eight European states after multiple regression analysis of risk factors associated with postoperative mortality in 19,030 patients undergoing cardiac surgery. The scoring system identifies three groups of risk factors with their assigned weights - patient-related risk factors, cardiac-related risk factors, surgery-related risk factors. The sum of the scores of risk factors gives the additive EuroSCORE which is equivalent to risk of mortality for that patient. (Malik, 2010).
Preoperative preparation for cardiac surgery includes physiological and psychological components. Physiological preparation includes history, physical examination, chest radiography, and an ECG. Effective preoperative teaching, which reduces anxiety and physiological responses to stress and after surgery, is an important aspect of psychological preparation. The surgical procedure, the intraoperative, and postoperative experiences are explained to the patient (Morton & Fontaine, 2009).
The aim of this study was to identify the risk factors leading to increased morbidity and mortality rate among cardiac surgery patients.
The study was conducted at the cardiothoracic surgery department and the post-operative intensive care unit of Assiut University Hospital. The sample of the study consisted of forty adult patients (male and female) undergoing open heart surgery.
Three tools were utilized in this study:
Tool I: Cardiac surgery patient needs assessment sheet: : This tool was divided into six parts socio demographic data, patients nursing needs pre cardiac surgery, laboratory investigation, diagnostic procedure, intraoperative, and post-operative data.
Tool 2: EuroSCORE ( European System for Cardiac Operative Risk Evaluation).
Is a risk stratification model for predicting the perioperative risk factors for mortality of patients undergoing cardiac surgery. The scoring system identifies three groups of risk factors with their assigned weights - patient-related risk factors, cardiac-related risk factors, and surgery-related risk factors. The sum of the scores of risk factors gives the additive Euro SCORE which is equivalent to risk of mortality for that patient..
The scoring system EuroSCORE
Low risk: (1-2).
Medium risk: (3-5).
High risk: (6 plus).
Tool 3: Observation checklist: It was developed by researcher after modifications were done based on reviewing related literature; theoretical and clinical learning experience of it. Researchers and expertise selected certain items to suite the aim of the study. Content validity of this tool was tested by expertise in medical and nursing staff. This tool was used to assess nurses’ practice while managing patients undergoing open heart surgery in different three times as ( preoperative, immediately postoperative and late postoperative period).
Data were collected in period of about six months; each patient was interviewed and counseled individually.
The statistical analysis was done using computer program (SPSS package version 18) and the following statistical measures were used: descriptive statistics including frequency, distribution, mean, and standard deviation were used to describe different characteristics. Also Kolmogorov – Smirnov test was used to examine the normality of data distribution. And lastly Univariate analyses including: t-test and Mann Whitney test, and Kruskal Wallis test.
The following results obtained from the study:
1. More than half of the studied group were male (72.5 %), were married (70%), 40% of patients have an age ranged from (18-29), 35% were illiterate & 33.5% were farmers.
2. The finding indicated that (65%) were rheumatic heart disease and the majority of patients had palpitation, dyspnea, and chest pain ( 95.0%, 85.0%, 82.5% respectively) while only 17.5% had edema in preoperative clinical assessment.
3. More than half of patients ( 65.0% ) had undergone valve disease repair and 38.6% had both aortic and mitral valve replacement.
4. Concerning number of vessels by passed and Logistic Euro score value the majority of patients (92.9 and 97.5 % respectively) had ≤ 3 vessels bypassed and ≤ 5.6 of Euro score value .
5. Significant relation was found between patient’s age and postoperative morbidity and mortality ( P= 0.043).
6. Non-significant relation was found between preoperative risk factors and postoperative morbidity and mortality regarding medical risk factors, medical history and hereditary disease.
7. Intra-operative assessment revealed that about half of patients (55.0%) had > 90 minutes of cardiopulmonary bypass while less than half of patients (47.5%) had ischemic time of > 90 minute, results also revealed that 60% had hypotension, and 77.5% had >260 minutes duration of surgery.
8. Post-operative assessment done revealed that the majority of patients had ≤ 8 hours of ventilation, an ICU length of stay >2, and a hospital length of stay >9 days (87.5% , 90%, and 97.5 respectively), 36.8% of patients had wound infection, 15% were dead during the postoperative period, and 66.6% of the causes of death were cardiogenic shock.
9. About half of patients had experienced post-operative morbidity .
10. Significant relation was found between occurrence of morbidity and EURO score as regard to patient- related factors (P =0.03) and Total EURO score (P=0.026).
11. A highly significant relation was found between occurrence of mortality and EURO score as regard to patient-related factors (P =0.001) and Total EURO score (P =0.0001).
12. No correlation has been found between hospital LOS, ICU-length of stay and EURO score among the studied group.
13. A highly significant relationship was found between EURO Score value and Post operative morbidity and mortality ( P = 0.001).
14. Significant relation was found between ischemic time, cardiopulmonary by pass time , time of ventilation, ICU length of stay (P = 0.033, P = 0.01, P = 0.006 , and P = 0.008 respectively) and post-operative morbidity and mortality.
15. Non-significant difference was found between preoperative nursing care and immediate nursing care and post-operative morbidity and mortality.
16. Significant relation was present between post-operative nursing care regarding pain management and incision site care and post-operative morbidity and mortality ( P= .021 and P= .012 respectively). <b.