Adjusting for Risk Associated With Pediatric and Congenital Cardiac Catheterization: A Report From the NCDR IMPACT Registry.
Adjusting for Risk Associated With Pediatric and Congenital Cardiac Catheterization: A Report From the NCDR IMPACT Registry.
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DOI：
10.1161/circulationaha.114.014694
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发表时间：
2015-11-17
期刊：
影响因子：
37.8
通讯作者：
Bergersen L
中科院分区：
文献类型：
--
作者：
Jayaram N;Beekman RH 3rd;Benson L;Holzer R;Jenkins K;Kennedy KF;Martin GR;Moore JW;Ringel R;Rome J;Spertus JA;Vincent R;Bergersen L
随着美国医疗保健越来越关注结果作为量化质量的手段，对风险模型的需求也越来越大，这些模型可以解释在不同医院接受治疗的患者的差异，以便在机构之间进行公平的比较。我们试图应用先前风险标准化方法的各个方面，以便开始为NCDR® IMPACT™（改进儿科和成人先天性治疗）登记研究开发风险标准化工具。使用IMPACT，确定了2011年1月至2013年3月期间接受诊断性或介入性心脏导管插入术的所有患者。多变量分层逻辑回归用于识别预测心导管插入术后发生主要不良事件的患者和手术特征。2011年1月至2013年3月期间，共进行了19，608次心脏导管插入术。在所有病例中，378例（1.9%）发生了重大不良事件。多变量校正后，确定了8个变量为风险标准化的关键因素：患者年龄、肾功能不全、单心室生理学、手术类型风险组、低全身饱和度、低混合静脉饱和度、全身心室舒张末期压升高和主肺动脉压升高。该模型具有良好的区分度（C-统计量为0.70），并通过自助验证（验证C-统计量为0.69）得到证实。以先前的风险标准化工作为基础，我们开发并内部验证了一个模型，用于预测先天性心脏病心导管插入术后主要不良事件的发生。未来的努力应针对进一步完善的模型变量在这个大的，多中心的数据集。
As US healthcare increasingly focuses upon outcomes as a means for quantifying quality, there is a growing demand for risk models that can account for the variability of patients treated at different hospitals so that equitable comparisons between institutions can be made. We sought to apply aspects of prior risk-standardization methodology in order to begin development of a risk-standardization tool for the NCDR® IMPACT™ (Improving Pediatric and Adult Congenital Treatment) Registry. Using IMPACT, all patients undergoing diagnostic or interventional cardiac catheterization between January 2011 and March 2013 were identified. Multivariable hierarchical logistic regression was used to identify patient and procedural characteristics predictive of experiencing a major adverse event following cardiac catheterization. A total of 19,608 cardiac catheterizations were performed between January 2011 and March 2013. Amongst all cases, a major adverse event occurred in 378 (1.9%) of all cases. After multivariable adjustment, eight variables were identified as critical for risk-standardization: patient age, renal insufficiency, single-ventricle physiology, procedure-type risk group, low systemic saturation, low mixed venous saturation, elevated systemic ventricular end diastolic pressure, and elevated main pulmonary artery pressures. The model had good discrimination (C-statistic of 0.70), confirmed by bootstrap validation (validation C-statistic of 0.69). Using prior risk-standardization efforts as a foundation, we developed and internally validated a model to predict the occurrence of a major adverse event following cardiac catheterization for congenital heart disease. Future efforts should be directed towards further refinement of the model variables within this large, multicenter dataset.