Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project☆
| Autor: | Paola, D'Errigo, Fulvia, Seccareccia, Stefano, Rosato, Valerio, Manno, Gabriella, Badoni, Danilo, Fusco, Carlo A, Perucci, B, Turinetto |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Population Hospital performance Risk Assessment Coronary artery bypass surgery Outcome Assessment Health Care medicine Humans Hospital Mortality Coronary Artery Bypass Risk factor education Aged education.field_of_study Models Statistical Hospitals Public business.industry Mortality rate EuroSCORE General Medicine Middle Aged Outcome (probability) Surgery Italy Female Cardiology and Cardiovascular Medicine Risk assessment business Demography |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 33:325-333 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/j.ejcts.2007.12.001 |
| Popis: | Objectives: To compare the risk-adjustment model empirically derived from the 'Italian CABG Outcome Project' with that of the additive and logistic EuroSCORE in terms of accuracy, predictive power and ability to rank hospital performances.Methods: The Italian CABG model, the logistic and additive EuroSCORE were applied to the Italian CABG population; the observed deaths/expected deaths (O/E) ratios, as obtained by the three models, werecomputedfor eachItaliancardiacsurgery centreandforsixclassesofrisk-stratifiedpatients.The performanceofthethreemodelsin predictingthe30-daymortalitywasformallyassessedforcalibration(Hosmer—Lemeshowtest)anddiscrimination(ROCarea).Accordingtothethree models, risk-adjusted mortality rates (RAMR = O/EItalian CABG population mortality rate) were estimated for each centre; possible differences were detected in the identification of hospitals with mortality rates higher and lower than average. Results: The Italian CABG model uses fewer variables than the EuroSCORE system (14 vs 17) and exhibits the best performance in terms of discrimination and calibration. Contrary to the other testedmodels,thelogisticEuroSCOREshowsasignificantHosmer—Lemeshowtest(x 2� L ¼ 19:30,p < 0.0001),indicatingunsatisfactorycalibration, and a clear predicteddeath overestimationineach ofthe consideredriskclasses(O/E = 0.4). When a proper recalibrationprocedure is applied, the logistic EuroSCORE performance parameters achieve acceptable levels. The Italian CABG model identified seven centres as having higher than averagemortality,whiletheEuroSCOREidentifiedthesamesevencentresplusoneother.TheItalianCABGmodelidentifiedeightcentreswithlower than average mortality, five of which were identified by the additive EuroSCORE and four of which were identified by the logistic EuroSCORE. The additiveEuroSCOREidentifiedfourmoreandthelogisticEuroSCOREthree morelowmortalitycentres.Conclusions:Althoughthisanalysisrevealsa satisfactoryconcordancebetweenresultsfromthethreemodels,adetailedcomparisonshowsthattheItalianCABGmodelusesfewervariablesand performsbetterthantheothers.Nevertheless,whenproperlyrecalibrated,theEuroSCOREmodelcanbeexportedtotheItalianpopulationandused to rank hospital performance and evaluate preoperative risk of patients undergoing open-heart surgery. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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