Assessing open heart surgery mortality in Catalonia (Spain) through a predictive risk model
Open Access
- 1 March 1997
- journal article
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 11 (3) , 415-423
- https://doi.org/10.1016/s1010-7940(96)01061-5
Abstract
OBJECTIVE: To develop a risk stratification model to assess open heartsurgery mortality in Catalonia (Spain) in order to use risk-adjustedhospital mortality rates as an approach to analyze quality of care.METHODS: Data were prospectively collected through a specific data- sheetduring 6 1/2 months in consecutive adult patients subjected to open heartsurgery. The dependent variable was surgical mortality, and independentvariables included were presurgical (sociodemographic data, clinicalantecedents, morphological and functional studies) and surgical. The modelwas built on a subsample (70% of study population) through univariate andlogistic regression analysis and validated in the rest of the sample.RESULTS: The total sample was of 1309 procedures in seven hospitals; 47% ofthem were valve procedures. The overall crude mortality rate was 10.9% andvaried among centers (range, 2.8-14.8%). Risk factors included in the modelreceived a weight based on the logistic regression coefficient and a scorewas generated for each patient. The factors with the highest weight werepatient older than 80 and second reoperation. Score was stratified in fivecategories of increasing risk. There was a good agreement between observedand predicted mortality rates in the validation group. Overall patientdistribution was as follows: 52% low risk level, 16% fair, 13% high, 12%very high, and 6% extremely high risk level. Mortality rate increased from4.2% in the low risk to 54.4% in the highest risk group. Case mixadjustment was performed through the risk score level. There werestatistically significant differences in the risk profiles of patientsadmitted among centers. After adjustment by risk profiles, there were nodifferences in mortality by hospital. CONCLUSION: A risk stratificationmodel through a multicentric, prospective and exhaustive collection of datain all types of open heart procedures was developed. In spite of widedifferences on crude rates and in the risk profiles of patients admitted,we did not find statistically significant differences in adjusted mortalityrates among centers. Timely and accurate information about surgicaloutcomes can lead to improvements in clinical practice and quality ofcare.Keywords
This publication has 15 references indexed in Scilit:
- Report Cards on Cardiac Surgeons — Assessing New York State's ApproachNew England Journal of Medicine, 1995
- A Comparison of Four Severity-Adjusted Models to Predict Mortality After Coronary Artery Bypass Graft SurgeryArchives of Surgery, 1995
- Risk stratification using the society of thoracic surgeons programThe Annals of Thoracic Surgery, 1994
- Comparing hospitals that perform coronary artery bypass surgery: the effect of outcome measures and data sources.American Journal of Public Health, 1994
- The Appropriateness of the Use of Cardiovascular Procedures: British Versus U.S. PerspectivesInternational Journal of Technology Assessment in Health Care, 1993
- Risk stratification for open heart surgery: trial of the Parsonnet system in a British hospital.BMJ, 1992
- Stratification of Morbidity and Mortality Outcome by Preoperative Risk Factors in Coronary Artery Bypass PatientsJAMA, 1992
- Adult Open Heart Surgery in New York StateJAMA, 1990
- A quality assurance model of operative mortality in coronary artery surgeryThe Annals of Thoracic Surgery, 1989
- A simple classification of the risk in cardiac surgeryCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1983