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Published on: March 27, 2018
Risk stratification of in-hospital mortality for coronary artery bypass graft surgery
Edward L Hannan1, Chuntao Wu, Edward V Bennett
1University at Albany, State University of New York, Albany, New York, USA.
Insights
A new risk index was developed to predict in-hospital mortality for coronary artery bypass graft (CABG) surgery using New York data. This tool accurately assesses patient risk and requires further validation across diverse regions.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Biostatistics
Background:
- Existing risk indexes for coronary artery bypass graft (CABG) surgery are crucial for assessing operative risk and profiling healthcare providers.
- There has been a lack of updated risk index development using population-based U.S. data for many years.
Purpose of the Study:
- To develop a novel risk index for predicting in-hospital mortality specifically for coronary artery bypass graft (CABG) surgery.
- To create a statistically sound model utilizing a limited set of patient risk factors.
Main Methods:
- Utilized data from New York's Cardiac Surgery Reporting System from 2002 to develop a predictive statistical model and risk index.
- Validated the index's performance by applying it to 2003 New York data, comparing expected versus observed mortality rates.
Main Results:
- The developed risk index incorporates 10 key patient factors, including age, gender, hemodynamic status, and comorbidities.
- The index yields scores ranging from 0 to 34, with 93% of patients scoring 8 or below.
- A C-statistic of 0.782 was achieved when the index was applied to a subsequent year's data, indicating good predictive accuracy.
Conclusions:
- The developed risk index demonstrates significant value in predicting patient risk for in-hospital mortality after CABG surgery.
- Further research is recommended to test this index against existing tools in various geographical settings.
Objectives:
The purpose of this research was to develop a risk index for in-hospital mortality for coronary artery bypass graft (CABG) surgery.
Background:
Risk indexes for CABG surgery are used to assess patients' operative risk as well as to profile hospitals and surgeons. None has been developed using data from a population-based region in the U.S. for many years.
Methods:
Data from New York's Cardiac Surgery Reporting System in 2002 were used to develop a statistical model that predicts mortality and to create a risk index based on a relatively small number of patient risk factors. The fit of the index was tested by applying it to another year (2003) of New York data and testing the correspondence of expected and observed mortality rates for each risk score in the index.
Results:
The risk index contains a total of 10 risk factors (age, female gender, hemodynamic state, ejection fraction, pre-procedural myocardial infarction, chronic obstructive pulmonary disease, calcified ascending aorta, peripheral arterial disease, renal failure, and previous open heart operations). The score possible for each variable ranges from 0 to 5, and total risk scores possible range from 0 to 34. The highest score observed for any patient was 22, and 93% of the patients had scores of 8 or lower. When the risk index was applied to another year of New York data with a considerably lower mortality rate, the C-statistic was 0.782.
Conclusions:
The risk index appears to be a valuable tool for predicting patient risk when applied to another year of New York data. It should now be tested against other risk indexes in a variety of geographical regions.