A Bayesian hierarchical approach to comparative audit for carotid surgery
| Autor: | E.C. Marshall, G. Kuhan, Peter T. McCollum, Ian Chetter, A.F. Abidia |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Adult
Carotid Artery Diseases Male medicine.medical_specialty Heart disease medicine.medical_treatment Bayesian probability Bayesian analysis Audit Carotid endarterectomy Hierarchical models Comparative audit Diabetes mellitus Outcome Assessment Health Care medicine Humans Stroke Aged Retrospective Studies Medicine(all) Aged 80 and over Endarterectomy Carotid Medical Audit Models Statistical business.industry Mortality rate Reproducibility of Results Bayes Theorem Middle Aged medicine.disease Surgery Survival Rate Ranking Emergency medicine WinBUGS Female Clinical Competence Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Vascular and Endovascular Surgery. 24:505-510 |
| ISSN: | 1078-5884 |
| DOI: | 10.1053/ejvs.2002.1763 |
| Popis: | Objectives: the aim of this study was to illustrate how a Bayesian hierarchical modelling approach can aid the reliable comparison of outcome rates between surgeons. Design: retrospective analysis of prospective and retrospective data. Materials: binary outcome data (death/stroke within 30 days), together with information on 15 possible risk factors specific for CEA were available on 836 CEAs performed by four vascular surgeons from 1992–99. The median patient age was 68 (range 38–86) years and 60% were men. Methods: the model was developed using the WinBUGS software. After adjusting for patient-level risk factors, a cross-validatory approach was adopted to identify "divergent" performance. A ranking exercise was also carried out. Results: the overall observed 30-day stroke/death rate was 3.9% (33/836). The model found diabetes, stroke and heart disease to be significant risk factors. There was no significant difference between the predicted and observed outcome rates for any surgeon (Bayesian p -value > 0.05). Each surgeon had a median rank of 3 with associated 95% CI 1.0–5.0, despite the variability of observed stroke/death rate from 2.9–4.4%. After risk adjustment, there was very little residual between-surgeon variability in outcome rate. Conclusions: Bayesian hierarchical models can help to accurately quantify the uncertainty associated with surgeons' performance and rank. |
| Databáze: | OpenAIRE |
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