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Establishing a Competing Risk Regression Nomogram Model for Survival Data

Published on: October 23, 2020

Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with

Victor T Tsang1, Katherine L Brown, Mats Johanssen Synnergren

  • 1Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom. tsangv@gosh.nhs.uk

The Annals of Thoracic Surgery
|January 24, 2009
PubMed

Insights

Pediatric congenital heart surgery risk models need regular recalibration. Outcomes improved, showing the original risk model became outdated, highlighting the need for updated risk adjustment in surgical audits.

Area of Science:

  • Pediatric Cardiac Surgery
  • Health Outcomes Research
  • Biostatistics

Background:

  • Risk adjustment in pediatric congenital heart surgery is complex due to diverse diagnoses and procedures.
  • Variable life-adjusted display (VLAD) charts effectively present risk-adjusted outcomes.
  • The long-term appropriateness of existing risk models requires ongoing evaluation.

Purpose of the Study:

  • To assess the performance of a previously developed risk model over time.
  • To compare predicted risk distributions between two patient cohorts.
  • To evaluate risk-adjusted outcomes using VLAD charts for a recent period.

Main Methods:

  • Utilized a graphic technique to evaluate an existing risk model with data from 2000-2003.
  • Compared predicted risk distributions between patients from 2000-2003 and 2004-2006.
  • Constructed a VLAD chart for risk-adjusted outcomes in the 2004-2006 cohort.

Main Results:

  • The risk model accurately predicted mortality above 3% but underestimated it between 2-3% and overestimated it below 2%.
  • Little difference was observed in predicted risk distributions between the 2000-2003 and 2004-2006 patient groups.
  • Observed outcomes in 2004-2006 were significantly better than predicted by the existing risk model, independent of case-mix changes.

Conclusions:

  • Risk adjustment models can become outdated over time.
  • Regular recalibration of risk models is essential for accurate surgical audits.
  • Complacency in risk-adjusted audits is a risk if models are not updated to reflect evolving standards and expectations.
Abstract

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