Risk models including high-risk cardiovascular procedures: Clinical predictors of mortality and morbidity

Hiroaki Miyata, Noboru Motomura, Hiroyuki Tsukihara, Shinichi Takamoto

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: While isolated coronary artery bypass grafting (CABG) poses major risks as well as benefits to cardiovascular surgery, procedures such as thoracic aortic surgery and combined CABG surgeries are also important contributors to mortality and morbidity. The objective of this study was to create and validate risk models including high-risk cardiovascular procedures to improve quality. Methods: The Japan Cardiovascular Surgery Database of patients enrolled cardiovascular surgical patients between January 2005 and December 2007. Data were collected at presentation and by physician review of clinical records and were verified through third-party surgeons' auditing. We analyzed 36. 780 procedures in 120 hospitals. Using logistic regression, risk models were generated and validated by split-sample validation. Results: In this analysis, 11. 948 procedures were isolated CABG, 11. 760 were valve surgeries, and 8440 were thoracic aortic surgeries. In a 30-day operative mortality risk model, 37 variables were significantly associated with outcome. In comparison to isolated CABG, the odds ratios (ORs) for a 30-day mortality were 1.81 for valve surgery (2.62 in mitral valve replacement and 2.72 in aortic valve plus mitral valve procedures) and 2.36 for thoracic aortic surgery (4.34 if indicated by rupture, 3.16 if involving only arch, 4.38 if involving distal aorta, 3.75 if descending, and 5.97 if thoraco-abdominal aorta). CABG combined with other procedures (n = 3599) had increased risks in each morbidity risk model (OR: 1.21 in reoperation, 1.60 in stroke, 1.23 in dialysis, 1.97 in infection, and 1.40 in prolonged ventilation). The predictive power of our models is valued by a C-statistic of 0.830 for a 30-day postoperative mortality, 0.639 for reoperation, 0.726 for stroke, 0.817 for dialysis, 0.692 for infection, and 0.796 for prolonged ventilation. Conclusions: Though performance of isolated CABG surgery was stable in this era, CABG combined with valve or thoracic aortic surgery was still a high-risk procedure. Given better recognition of high patient risk from these models, earlier targeted perioperative interventions may reduce adverse effects.

Original languageEnglish
Pages (from-to)667-674
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume39
Issue number5
DOIs
Publication statusPublished - 2011 May
Externally publishedYes

Fingerprint

Coronary Artery Bypass
Morbidity
Mortality
Thoracic Surgery
Mitral Valve
Reoperation
Ventilation
Dialysis
Stroke
Odds Ratio
Abdominal Aorta
Infection
Thoracic Aorta
Aortic Valve
Rupture
Japan
Logistic Models
Databases
Physicians

Keywords

  • Cardiovascular surgery
  • Coronary artery disease
  • Quality improvement
  • Risk model
  • Thoracic aortic disease
  • Valve disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Risk models including high-risk cardiovascular procedures : Clinical predictors of mortality and morbidity. / Miyata, Hiroaki; Motomura, Noboru; Tsukihara, Hiroyuki; Takamoto, Shinichi.

In: European Journal of Cardio-thoracic Surgery, Vol. 39, No. 5, 05.2011, p. 667-674.

Research output: Contribution to journalArticle

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abstract = "Objective: While isolated coronary artery bypass grafting (CABG) poses major risks as well as benefits to cardiovascular surgery, procedures such as thoracic aortic surgery and combined CABG surgeries are also important contributors to mortality and morbidity. The objective of this study was to create and validate risk models including high-risk cardiovascular procedures to improve quality. Methods: The Japan Cardiovascular Surgery Database of patients enrolled cardiovascular surgical patients between January 2005 and December 2007. Data were collected at presentation and by physician review of clinical records and were verified through third-party surgeons' auditing. We analyzed 36. 780 procedures in 120 hospitals. Using logistic regression, risk models were generated and validated by split-sample validation. Results: In this analysis, 11. 948 procedures were isolated CABG, 11. 760 were valve surgeries, and 8440 were thoracic aortic surgeries. In a 30-day operative mortality risk model, 37 variables were significantly associated with outcome. In comparison to isolated CABG, the odds ratios (ORs) for a 30-day mortality were 1.81 for valve surgery (2.62 in mitral valve replacement and 2.72 in aortic valve plus mitral valve procedures) and 2.36 for thoracic aortic surgery (4.34 if indicated by rupture, 3.16 if involving only arch, 4.38 if involving distal aorta, 3.75 if descending, and 5.97 if thoraco-abdominal aorta). CABG combined with other procedures (n = 3599) had increased risks in each morbidity risk model (OR: 1.21 in reoperation, 1.60 in stroke, 1.23 in dialysis, 1.97 in infection, and 1.40 in prolonged ventilation). The predictive power of our models is valued by a C-statistic of 0.830 for a 30-day postoperative mortality, 0.639 for reoperation, 0.726 for stroke, 0.817 for dialysis, 0.692 for infection, and 0.796 for prolonged ventilation. Conclusions: Though performance of isolated CABG surgery was stable in this era, CABG combined with valve or thoracic aortic surgery was still a high-risk procedure. Given better recognition of high patient risk from these models, earlier targeted perioperative interventions may reduce adverse effects.",
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N2 - Objective: While isolated coronary artery bypass grafting (CABG) poses major risks as well as benefits to cardiovascular surgery, procedures such as thoracic aortic surgery and combined CABG surgeries are also important contributors to mortality and morbidity. The objective of this study was to create and validate risk models including high-risk cardiovascular procedures to improve quality. Methods: The Japan Cardiovascular Surgery Database of patients enrolled cardiovascular surgical patients between January 2005 and December 2007. Data were collected at presentation and by physician review of clinical records and were verified through third-party surgeons' auditing. We analyzed 36. 780 procedures in 120 hospitals. Using logistic regression, risk models were generated and validated by split-sample validation. Results: In this analysis, 11. 948 procedures were isolated CABG, 11. 760 were valve surgeries, and 8440 were thoracic aortic surgeries. In a 30-day operative mortality risk model, 37 variables were significantly associated with outcome. In comparison to isolated CABG, the odds ratios (ORs) for a 30-day mortality were 1.81 for valve surgery (2.62 in mitral valve replacement and 2.72 in aortic valve plus mitral valve procedures) and 2.36 for thoracic aortic surgery (4.34 if indicated by rupture, 3.16 if involving only arch, 4.38 if involving distal aorta, 3.75 if descending, and 5.97 if thoraco-abdominal aorta). CABG combined with other procedures (n = 3599) had increased risks in each morbidity risk model (OR: 1.21 in reoperation, 1.60 in stroke, 1.23 in dialysis, 1.97 in infection, and 1.40 in prolonged ventilation). The predictive power of our models is valued by a C-statistic of 0.830 for a 30-day postoperative mortality, 0.639 for reoperation, 0.726 for stroke, 0.817 for dialysis, 0.692 for infection, and 0.796 for prolonged ventilation. Conclusions: Though performance of isolated CABG surgery was stable in this era, CABG combined with valve or thoracic aortic surgery was still a high-risk procedure. Given better recognition of high patient risk from these models, earlier targeted perioperative interventions may reduce adverse effects.

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KW - Cardiovascular surgery

KW - Coronary artery disease

KW - Quality improvement

KW - Risk model

KW - Thoracic aortic disease

KW - Valve disease

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