The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 1-Statistical Methodology
The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 1-Statistical Methodology
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DOI：
10.1016/j.athoracsur.2015.07.014
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发表时间：
2015-09-01
影响因子：
4.6
通讯作者：
Jacobs, Marshall L.
中科院分区：
文献类型：
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作者：
O'Brien, Sean M.;Jacobs, Jeffrey P.;Jacobs, Marshall L.
背景本研究的目的是建立一个风险模型，将手术类型和患者因素结合起来，用于先天性心脏病手术后医院特定手术死亡率分析中的病例组合调整。纳入了2010年1月1日至2013年12月31日期间在参与胸外科学会先天性心脏手术数据库的中心接受心脏手术（有或无心肺转流）的所有年龄的患者。排除了体重小于或等于2.5 kg患者的孤立性动脉导管未闭闭合术、缺失数据超过10%的中心和关键变量数据缺失的患者。前3.5年的数据用于模型开发，最后0.5年的数据用于评估模型区分和校准。根据专家共识提出了潜在的风险因素，并在经验上比较了各种建模方案后进行了选择。研究队列包括来自86个中心的52，224例患者，其中1，931例死亡（3.7%）。模型中包括的协变量为初次手术、年龄、体重和11个额外的患者因素，这些因素反映了急性状态和合并症。验证样本中的C统计量为0.858。预测死亡率与预期死亡率的曲线显示总体和亚组内的校准良好，除了预测风险最高十分位数的风险略有高估。从模型中去除患者术前因素后，C统计量降至0.831，并影响了86家医院中12家的绩效分类。该风险模型非常适合在先天性心脏病手术医院特异性死亡率的分析和报告中调整病例组合。纳入患者因素增加了有用的判别力，并减少了医院特异性死亡率指标计算中的偏倚。(C)2015年美国胸外科医师协会
Background. This study's objective was to develop a risk model incorporating procedure type and patient factors to be used for case-mix adjustment in the analysis of hospital-specific operative mortality rates after congenital cardiac operations.Methods. Included were patients of all ages undergoing cardiac operations, with or without cardiopulmonary bypass, at centers participating in The Society of Thoracic Surgeons Congenital Heart Surgery Database during January 1, 2010, to December 31, 2013. Excluded were isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg, centers with more than 10% missing data, and patients with missing data for key variables. Data from the first 3.5 years were used for model development, and data from the last 0.5 year were used for assessing model discrimination and calibration. Potential risk factors were proposed based on expert consensus and selected after empirically comparing a variety of modeling options.Results. The study cohort included 52,224 patients from 86 centers with 1,931 deaths (3.7%). Covariates included in the model were primary procedure, age, weight, and 11 additional patient factors reflecting acuity status and comorbidities. The C statistic in the validation sample was 0.858. Plots of observed-vs-expected mortality rates revealed good calibration overall and within subgroups, except for a slight overestimation of risk in the highest decile of predicted risk. Removing patient preoperative factors from the model reduced the C statistic to 0.831 and affected the performance classification for 12 of 86 hospitals.Conclusions. The risk model is well suited to adjust for case mix in the analysis and reporting of hospital-specific mortality for congenital heart operations. Inclusion of patient factors added useful discriminatory power and reduced bias in the calculation of hospital-specific mortality metrics. (C) 2015 by The Society of Thoracic Surgeons