Operative Mortality and Complication Risk Model for All Major Cardiovascular Operations in Japan
Operative Mortality and Complication Risk Model for All Major Cardiovascular Operations in Japan
复制标题
DOI：
10.1016/j.athoracsur.2014.07.038
复制
发表时间：
2015-01-01
影响因子：
4.6
通讯作者：
Takamoto, Shinichi
中科院分区：
文献类型：
--
作者：
Miyata, Hiroaki;Tomotaki, Ai;Takamoto, Shinichi
背景。日本心血管手术数据库（JCVSD）是一个全国性的基准项目，旨在提高日本心血管手术的质量。本研究旨在建立新的JACVD风险模型，不仅包括手术死亡率，还包括冠状动脉旁路移植术（CABG）、瓣膜手术和胸主动脉手术的各种术后并发症。我们分析了24,704例孤立CABG手术，26,137例瓣膜手术和18,228例胸主动脉手术。为每次手术建立手术死亡、永久性卒中、肾功能衰竭、延长通气时间（bbb24小时）、胸骨深部伤口感染和再次手术出血的风险模型。总体分为80%的开发样本和20%的验证样本。采用多元logistic回归分析建立统计模型。用受试者工作特征曲线下面积（C指数）检验模型辨别力。孤立性冠状动脉搭桥、瓣膜手术和胸主动脉手术的30天死亡率分别为1.5%、2.5%和6.0%，手术死亡率分别为2.4%、3.8%和8.4%。孤立性冠状动脉搭桥、瓣膜手术和胸主动脉手术的终点C指数分别为0.6358（胸骨深部感染）~ 0.8655（手术死亡率）、0.6114（因出血再手术）~ 0.8319（手术死亡）、0.6311（胃肠道并发症）~ 0.7591（手术死亡）。这些风险模型增加了以前模型的歧视性。因此，我们的模式可以说是反映了日本的现状。关于主要并发症，现在可以通过日本心血管外科数据库网络系统提供有用的反馈。(C) 2015年由胸外科学会发布
Background. The Japan Cardiovascular Surgery Database (JCVSD) is a nationwide benchmarking project to improve the quality of cardiovascular surgery in Japan. This study aimed to develop new JACVD risk models not only for operative mortality but also for each postoperative complication for coronary artery bypass grafting (CABG) operations, valve operations, and thoracic aortic operations.Methods. We analyzed 24,704 isolated CABG operations, 26,137 valve operations, and 18,228 thoracic aortic operations. Risk models were developed for each operation for operative death, permanent stroke, renal failure, prolonged ventilation (> 24 hours), deep sternal wound infection, and reoperation for bleeding. The population was divided into an 80% development sample and a 20% validation sample. The statistical model was constructed by multiple logistic regression analysis. Model discrimination was tested using the area under the receiver operating characteristic curve (C index).Results. The 30-day mortality rates for isolated CABG, valve, and thoracic aortic operations were 1.5%, 2.5%, and 6.0%, respectively, and operative mortality rates were 2.4%, 3.8%, and 8.4%, respectively. The C indices for the end points of isolated CABG, valve, and aortic thoracic operations were 0.6358 for (deep sternal infection) to 0.8655 (operative mortality), 0.6114 (reoperation for bleeding) to 0.8319 (operative death), and 0.6311 (gastrointestinal complication) to 0.7591 (operative death), respectively.Conclusions. These risk models increased the discriminatory power of former models. Thus, our models can be said to reflect the current state of Japan. With respect to major complications, useful feedback can now be provided through the Japan Cardiovascular Surgery Database Web-based system. (C) 2015 by The Society of Thoracic Surgeons