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. 1998 Apr;79(4):350–355. doi: 10.1136/hrt.79.4.350

Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms

B Bridgewater 1, H Neve 1, N Moat 1, T Hooper 1, M Jones 1
PMCID: PMC1728667  PMID: 9616341

Abstract

Objective—To compare the ability of four risk models to predict operative mortality after coronary artery bypass graft surgery (CABG) in the United Kingdom.
Design—Prospective study.
Setting—Two cardiothoracic centres in the United Kingdom.
Subjects—1774 patients having CABG.
Main outcome measures—Risk factors were recorded for all patients, along with in-hospital mortality. Predicted mortality was derived from the American Society of Thoracic Surgeons (STS) risk program, Ontario Province risk score (PACCN), Parsonnet score, and the UK Society of Cardiothoracic Surgeons risk algorithm.
Results—There were significant differences (p < 0.05) between the British and American populations from which the STS risk algorithm was derived with respect to most variables. The observed mortality in the British population was 3.7% (65 of 1774). The mean pre- dicted mortality by STS score, PACCN, Parsonnet score, and UK algorithms were 1.1%, 1.6%, 4.6%, and 4.7% respectively. The overall predictive ability of the models as measured by the area under the receiver operating characteristic curve were 0.64, 0.60, 0.73, and 0.75, respectively.
Conclusions—There are differences between the British and American populations for CABG and the North American algorithms are not useful for predicting mortality in the United Kingdom. The UK Society of Cardiothoracic Surgeons algorithm is the best of the models tested but still only has limited predictive ability. Great care must be exercised when using methods of this type for comparisons of units and surgeons.

 Keywords: cardiac surgery;  risk stratification;  audit

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allan A., Forsyth A. T. Risk stratification for open heart surgery. BMJ. 1992 Dec 12;305(6867):1500–1501. doi: 10.1136/bmj.305.6867.1500-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Clark R. E. Calculating risk and outcome: The Society of Thoracic Surgeons database. Ann Thorac Surg. 1996 Nov;62(5 Suppl):S2–S32. doi: 10.1016/0003-4975(96)00818-1. [DOI] [PubMed] [Google Scholar]
  3. Dubois R. W., Rogers W. H., Moxley J. H., 3rd, Draper D., Brook R. H. Hospital inpatient mortality. Is it a predictor of quality? N Engl J Med. 1987 Dec 24;317(26):1674–1680. doi: 10.1056/NEJM198712243172626. [DOI] [PubMed] [Google Scholar]
  4. Dupuis J. Y., Wynands J. E. Risk-adjusted mortality to assess quality of care in cardiac surgery. Can J Anaesth. 1993 Feb;40(2):91–97. doi: 10.1007/BF03011303. [DOI] [PubMed] [Google Scholar]
  5. Edwards F. H., Clark R. E., Schwartz M. Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experience. Ann Thorac Surg. 1994 Jan;57(1):12–19. doi: 10.1016/0003-4975(94)90358-1. [DOI] [PubMed] [Google Scholar]
  6. Grover F. L., Johnson R. R., Shroyer A. L., Marshall G., Hammermeister K. E. The Veterans Affairs Continuous Improvement in Cardiac Surgery Study. Ann Thorac Surg. 1994 Dec;58(6):1845–1851. doi: 10.1016/0003-4975(94)91725-6. [DOI] [PubMed] [Google Scholar]
  7. Hattler B. G., Madia C., Johnson C., Armitage J. M., Hardesty R. L., Kormos R. L., Pham S. M., Payne D. N., Griffith B. P. Risk stratification using the Society of Thoracic Surgeons Program. Ann Thorac Surg. 1994 Nov;58(5):1348–1352. doi: 10.1016/0003-4975(94)91911-9. [DOI] [PubMed] [Google Scholar]
  8. Marshall G., Shroyer A. L., Grover F. L., Hammermeister K. E. Bayesian-logit model for risk assessment in coronary artery bypass grafting. Ann Thorac Surg. 1994 Jun;57(6):1492–1500. doi: 10.1016/0003-4975(94)90107-4. [DOI] [PubMed] [Google Scholar]
  9. Nashef S. A., Carey F., Silcock M. M., Oommen P. K., Levy R. D., Jones M. T. Risk stratification for open heart surgery: trial of the Parsonnet system in a British hospital. BMJ. 1992 Oct 31;305(6861):1066–1067. doi: 10.1136/bmj.305.6861.1066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. O'Connor G. T., Plume S. K., Olmstead E. M., Coffin L. H., Morton J. R., Maloney C. T., Nowicki E. R., Levy D. G., Tryzelaar J. F., Hernandez F. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group. Circulation. 1992 Jun;85(6):2110–2118. doi: 10.1161/01.cir.85.6.2110. [DOI] [PubMed] [Google Scholar]
  11. Spiegelhalter D. J. Risk stratification for open heart surgery. BMJ. 1992 Dec 12;305(6867):1500–1500. doi: 10.1136/bmj.305.6867.1500-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Swets J. A. Measuring the accuracy of diagnostic systems. Science. 1988 Jun 3;240(4857):1285–1293. doi: 10.1126/science.3287615. [DOI] [PubMed] [Google Scholar]
  13. Treasure T. Risks and results of surgery. Br Heart J. 1995 Jul;74(1):11–12. doi: 10.1136/hrt.74.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Tu J. V., Jaglal S. B., Naylor C. D. Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation. 1995 Feb 1;91(3):677–684. doi: 10.1161/01.cir.91.3.677. [DOI] [PubMed] [Google Scholar]

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