Ready-made, recalibrated, or remodeled? Issues in the use of risk indexes for assessing mortality after coronary artery bypass graft surgery
Ready-made, recalibrated, or remodeled? Issues in the use of risk indexes for assessing mortality after coronary artery bypass graft surgery
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DOI：
10.1161/01.cir.99.16.2098
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发表时间：
1999-04-27
期刊：
影响因子：
37.8
通讯作者：
Naylor, CD
中科院分区：
文献类型：
--
作者：
Ivanov, J;Tu, JV;Naylor, CD
背景-心脏手术后手术死亡率的风险指数用于外科医生或中心的比较分析。我们检查了临床医生和管理人员是否应该不加修改地使用现有指数，针对其人群重新校准它，或者完全导出一个新模型。 方法和结果-根据 1993 年至 1996 年间在多伦多两家教学医院接受孤立 CABG 的 7491 名连续患者，我们比较了 3 种策略：(1) 使用最初在我们的管辖范围内导出和验证的现成模型；(2) 重新校准现成模型以更好地适应人群；(3) 重新校准现成模型以更好地适应人群； (3) 推导带有附加风险因素的新模型。我们评估了统计准确性；即，接受者-操作者特征曲线（ROC）下的面积；精度，即统计拟合优度；以及对 14 名外科医生的风险调整手术死亡率 (RAOM) 和绩效排名的实际影响。：新模型比现成模型稍微更准确（ROC，0.78 与 0.76；P
Background-Risk indexes for operative mortality after-cardiac surgery are used for comparative profiling of surgeons or centers. We examined-whether clinicians and managers should use an existing index without modification, recalibrate it for their populations, or derive a new model altogether.Methods and Results-Drawing on 7491 consecutive patients who underwent isolated CABG at 2 Toronto teaching hospitals between 1993 and 1996, we compared 3 strategies: (1) using a ready-made model originally derived and validated in our jurisdiction;:, (2) recalibrating the ready-made model to better fit the population; and (3) deriving anew model with additional risk factors. We assessed statistical accuracy; ie, area under a receiver-operator characteristic curve(ROC); precision, ie, statistical goodness-of-fit; and actual impact on both risk-adjusted operative mortalities,(RAOM) and performance rankings for 14 surgeons.:The new model was slightly more accurate than the ready-made model (ROC, 0.78 versus 0.76; P