The society of thoracic surgeons: 30-Day operative mortality and morbidity risk models

A. Laurie W. Shroyer, Laura P. Coombs, Eric D. Peterson, Mary C. Eiken, Elizabeth R. DeLong, Anita Chen, T. Bruce Ferguson, Frederick L. Grover, Fred H. Edwards, Roger J.F. Baskett, John C. Chen

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

540 Citas (Scopus)

Resumen

Background. Although 30day risk-adjusted operative mortality (ROM) has been used for quality assessment, it is not sufficient to describe the outcomes after coronary artery bypass grafting (CABG) surgery. Risk-adjusted major morbidity may differentially impact quality of care (as complications occur more frequently than death) and enhance a surgical team's ability to assess their quality. This study identified the preoperative risk factors associated with several complications and a composite outcome (the presence of any major morbidity or 30-day operative mortality or both). Methods. For CABG procedures, the 1997 to 1999 Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database was used to develop ROM and risk-adjusted morbidity (ROMB) models. Risk factors were selected using standard STS univariate screening and multivariate logistic regression approaches. Risk model performance was assessed. Across STS participating sites, the association of observed-to-expected (O/E) ratios for ROM and ROMB was evaluated. Results. The 30-day operative death and major complication rates for STS CABG procedures were 3.05% and 13.40%, respectively (503,478 CABG procedures), including stroke (1.63%), renal failure (3.53%), reoperation (5.17%), prolonged ventilation (5.96%), and sternal infection (0.63%). Risk models were developed (c-indexes for stroke [0.72], renal failure [0.76], reoperation [0.64], prolonged ventilation [0.75], sternal infection [0.66], and the composite endpoint [0.71]). Only a slight correlation was found, however, between ROMB and ROM indicators. Conclusions. Used in combination, ROMB and ROM may provide the surgical team with additional information to evaluate the quality of their care as well as valuable insights to allow them to focus on areas for improvement.

Idioma originalEnglish
Páginas (desde-hasta)1856-1865
Número de páginas10
PublicaciónAnnals of Thoracic Surgery
Volumen75
N.º6
DOI
EstadoPublished - jun. 1 2003

Nota bibliográfica

Funding Information:
Doctor Shroyer’s participation in this project was supported in part by funding from the Department of Veterans Affairs’ Health Services Research and Development Office (Grant IHY 99214–1, Dr Shroyer Principal Investigator), the VA Office of Patient Care Services, and the VA Office of Quality and Performance, VA Headquarters, Washington, DC. The authors wish to thank all of the participants of the STS National Database Committee for their support to make this risk-adjusted mortality/morbidity study possible. The authors are grateful to Bradley G. Hammill, MS, and Amy M. Krambrink, BS, at the Duke Clinical Research Institute (DCRI) for their outstanding efforts to provide support for this project.

ASJC Scopus Subject Areas

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

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