The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models: Part 1-Coronary Artery Bypass Grafting Surgery
The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models: Part 1-Coronary Artery Bypass Grafting Surgery
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DOI：
10.1016/j.athoracsur.2009.05.053
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发表时间：
2009-07-01
影响因子：
4.6
通讯作者：
Anderson, Richard P.
中科院分区：
文献类型：
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作者：
Shahian, David M.;O'Brien, Sean M.;Anderson, Richard P.
背景胸外科医师协会国家成人心脏手术数据库（STS NCD）的第一版是近20年前开发的。自成立以来，参与者数量急剧增加，患者敏锐度提高，总体结果不断改善。为了适应这些和其他变化，所有STS风险模型都进行了定期修订。本报告提供了2008年冠状动脉旁路移植术（CABG）STS风险模型的详细描述。研究人群包括2002年1月1日至2006年12月31日期间在819家STS NCD参与中心对年龄在20至100岁之间的成年患者进行的774，881例孤立CABG手术。该队列随机分为60%的培训（开发）样本和40%的测试（验证）样本。开发样本用于识别预测变量和估计模型系数。验证样品用于评估模型校准和区分度。模型结局包括手术死亡率、肾衰竭、卒中、任何原因的再次手术、通气时间延长、深部胸骨伤口感染、复合主要发病率或死亡率、住院时间延长（> 14天）和住院时间短（< 6天且存活）。根据STS NCD版本2.35、2.41和2.52.1中的可用性及其在版本2.61中的存在（或映射到版本2.61的能力）选择候选预测变量。筛选潜在的预测变量，包括研究人群的总体患病率、缺失数据频率、编码问题、与结局的双变量关系，以及它们在既往STS或其他CABG风险模型中的存在。然后在心脏外科医生和生物统计学家专家小组的输入下进行监督向后选择。成功验证模型拟合后，随后合并开发和验证样品，并使用总体合并（开发加验证）样品估计最终回归系数。结果。死亡率模型的c指数为0.812，验证样本中其他终点的c指数范围为0.653（再次手术）至0.793（肾衰竭）。观察到的事件发生率与预测的事件发生率的曲线图显示，在总体人群和许多亚组中，校准是可接受的。当将患者分组为预测风险类别时，每个终点的观察和预期事件发生率之间的绝对差异小于1.5%。最后给出了模型的截距和系数。针对CABG死亡率和其他8个终点，已经开发了新的STS风险模型。模型开发和测试的详细说明，以及最终的算法。整体模型性能非常出色。(Ann Thorac Surg 2009;88：S2-22）（C）2009，胸外科医师协会
Background. The first version of The Society of Thoracic Surgeons National Adult Cardiac Surgery Database (STS NCD) was developed nearly 2 decades ago. Since its inception, the number of participants has grown dramatically, patient acuity has increased, and overall outcomes have consistently improved. To adjust for these and other changes, all STS risk models have undergone periodic revisions. This report provides a detailed description of the 2008 STS risk model for coronary artery bypass grafting surgery (CABG).Methods. The study population consisted of 774,881 isolated CABG procedures performed on adult patients aged 20 to 100 years between January 1, 2002, and December 31, 2006, at 819 STS NCD participating centers. This cohort was randomly divided into a 60% training (development) sample and a 40% test (validation) sample. The development sample was used to identify predictor variables and estimate model coefficients. The validation sample was used to assess model calibration and discrimination. Model outcomes included operative mortality, renal failure, stroke, reoperation for any cause, prolonged ventilation, deep sternal wound infection, composite major morbidity or mortality, prolonged length of stay (> 14 days), and short length of stay (< 6 days and alive). Candidate predictor variables were selected based on their availability in versions 2.35, 2.41, and 2.52.1 of the STS NCD and their presence in (or ability to be mapped to) version 2.61. Potential predictor variables were screened for overall prevalence in the study population, missing data frequency, coding concerns, bivariate relationships with outcomes, and their presence in previous STS or other CABG risk models. Supervised backwards selection was then performed with input from an expert panel of cardiac surgeons and biostatisticians. After successfully validating the fit of the models, the development and validation samples were subsequently combined, and the final regression coefficients were estimated using the overall combined (development plus validation) sample.Results. The c-index for the mortality model was 0.812, and the c-indices for other endpoints ranged from 0.653 for reoperation to 0.793 for renal failure in the validation sample. Plots of observed versus predicted event rates revealed acceptable calibration in the overall population and in numerous subgroups. When patients were grouped into categories of predicted risk, the absolute difference between the observed and expected event rates was less than 1.5% for each endpoint. The final model intercept and coefficients are provided.Conclusions. New STS risk models have been developed for CABG mortality and eight other endpoints. Detailed descriptions of model development and testing are provided, together with the final algorithm. Overall model performance is excellent. (Ann Thorac Surg 2009;88:S2-22) (C) 2009 by The Society of Thoracic Surgeons