Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms
Open Access
- 1 April 1998
- Vol. 79 (4) , 350-355
- https://doi.org/10.1136/hrt.79.4.350
Abstract
Objective To compare the ability of four risk models to predict operative mortality after coronary artery bypass graft surgery (CABG) in the United Kingdom. Design Prospective study. Setting Two cardiothoracic centres in the United Kingdom. Subjects 1774 patients having CABG. Main outcome measures Risk factors were recorded for all patients, along with in-hospital mortality. Predicted mortality was derived from the American Society of Thoracic Surgeons (STS) risk program, Ontario Province risk score (PACCN), Parsonnet score, and the UK Society of Cardiothoracic Surgeons risk algorithm. Results There were significant differences (p < 0.05) between the British and American populations from which the STS risk algorithm was derived with respect to most variables. The observed mortality in the British population was 3.7% (65 of 1774). The mean pre- dicted mortality by STS score, PACCN, Parsonnet score, and UK algorithms were 1.1%, 1.6%, 4.6%, and 4.7% respectively. The overall predictive ability of the models as measured by the area under the receiver operating characteristic curve were 0.64, 0.60, 0.73, and 0.75, respectively. Conclusions There are differences between the British and American populations for CABG and the North American algorithms are not useful for predicting mortality in the United Kingdom. The UK Society of Cardiothoracic Surgeons algorithm is the best of the models tested but still only has limited predictive ability. Great care must be exercised when using methods of this type for comparisons of units and surgeons.Keywords
This publication has 14 references indexed in Scilit:
- Calculating risk and outcome: The society of thoracic surgeons databaseThe Annals of Thoracic Surgery, 1996
- Risks and results of surgery.Heart, 1995
- The veterans affairs continuous improvement in cardiac surgery studyThe Annals of Thoracic Surgery, 1994
- Risk stratification using the society of thoracic surgeons programThe Annals of Thoracic Surgery, 1994
- Bayesian-logit model for risk assessment in coronary artery bypass graftingThe Annals of Thoracic Surgery, 1994
- Coronary artery bypass grafting: The Society of Thoracic Surgeons National Database experienceThe Annals of Thoracic Surgery, 1994
- Risk-adjusted mortality to assess quality of care in cardiac surgeryCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1993
- Risk stratification for open heart surgery: trial of the Parsonnet system in a British hospital.BMJ, 1992
- Measuring the Accuracy of Diagnostic SystemsScience, 1988
- Hospital Inpatient MortalityNew England Journal of Medicine, 1987