To revalidate a local model for prediction of in-hospital mortality after coronary surgery several years after its introduction and the EuroSCORE in a specific area within its original scope. To assess the specific advantages of one type of instrument over the other in a definite context.
Study Design and Setting
Data from consecutive patients undergoing a first isolated coronary artery bypass between November 2001 and November 2003 in five hospitals in Catalonia were prospectively collected.
The study included 1,605 patients. Areas under the receiver-operating characteristics curves were around 0.75 for both models. Calibration was low for both models and the local model significantly overestimated risk. The ordering of operating centers by performance was identical with each strategy but the centers labeled as outliers differed.
(1) Evaluation of performance of individual hospitals was consistent using both systems and almost identical when they were internally recalibrated, (2) The impact of the benchmark population characteristics on model performance may be greater than that of risk factors considered for score calculation, (3) Promoting the use of a widely used instrument as the EuroSCORE might be sufficient for most evaluations. Local scales can be useful to highlight locally relevant features and temporal trends.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Clinical Epidemiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Intra-institutional prediction of outcome after cardiac surgery: comparison between a locally derived model and the EuroSCORE.Eur J Cardio-thorac Surg. 2000; 18: 703-710
- Limitations of current risk-adjustment models in the era of coronary stenting.Am Heart J. 2003; 145: 683-692
- European system for cardiac operative risk evaluation (EuroSCORE).Eur J Cardio-thorac Surg. 1999; 16: 9-13
- Does EuroSCORE work in individual European countries?.Eur J Cardio-thorac Surg. 2000; 18: 27-30
- Assessing open heart surgery mortality in Catalonia (Spain) through a predictive risk model.Eur J Cardio-thorac Surg. 1997; 11: 415-423
- The logistic EuroSCORE.Eur Heart J. 2003; 24: 1-2
- Comparing areas under two or more correlated receiver operating curves: a nonparametric approach.Biometrics. 1988; 44: 837-845
- Comparing risk-adjustment methods for provider profiling.Stat Med. 1997; 16: 2645-2664
- Equally valid models gave divergent predictions for mortality in acute myocardial infarction patients in a comparison of logical regression models.J Clin Epidemiol. 2005; 58: 383-390
- McNeil B.J. The meaning and use of the area under receiver operating characteristic (ROC) curve. Radiology. 143. 1992: 29-36
- Ready-made, recalibrated, or remodeled? Issues in the use of risk indexes for assessing mortality after coronary artery bypass graft surgery.Circulation. 1999; 99: 2098-2104
- Challenges in comparing risk-adjusted bypass surgery mortality results.JACC. 2000; 36: 2174-2184
- Assessing quality and outcomes for percutaneous coronary intervention: choosing statistical models, outcomes, time periods, and patient populations.Am Heart J. 2003; 145: 571-574
- Trends in coronary artery bypass surgery: changing type of surgical patient.Rev Esp Cardiol. 2005; 58: 512-522
- Open heart surgery in public and private practice.J Health Serv Res Policy. 1999; 4: 73-78
- Moral I and the CIRCORCA study group. Outcomes of coronary artery surgery: determinants of quality of live related to postoperative health.Rev Esp Cardiol. 2001; 54: 607-616
- Subjective versus statistical assessment of mortality risk in open heart surgical procedures.Ann thorac Surg. 1999; 67: 635-640
- A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases.Ann Surg. 2001; 234: 464-472
- Cardiac surgery risk models: a position article.Ann Thorac Surg. 2004; 78: 1868-1877
Accepted: October 2, 2006
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.