Abstract
Objective
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.
Results
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.
Conclusion
(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.
Keywords
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Article info
Publication history
Accepted:
October 2,
2006
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
