Benchmark of Intraoperative Activity in Cardiac Surgery: A Comparison between Pre- and Post-Operative Prognostic Models

Benchmark of Intraoperative Activity in Cardiac Surgery: A Comparison between Pre- and Post-Operative Prognostic Models

Despite its large diffusion and improvements in safety, the risks of complications after cardiac surgery remain high. Published predictive perioperative scores (EUROSCORE, STS, ACEF) assess risk on preoperative data only, not accounting for the intraopertive period. We propose a double-fold model, i...

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Bibliographic Details
Published in:Journal of clinical medicine Vol. 11; no. 11; p. 3231
Main Authors: Zamperoni, Anna, Carrara, Greta, Greco, Massimiliano, Rossi, Carlotta, Garbero, Elena, Nattino, Giovanni, Minniti, Giuseppe, Del Sarto, Paolo, Bertolini, Guido, Finazzi, Stefano, Cardiac Surgical Intensive Care Writing Committee GiViTI
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 06-06-2022
MDPI
Subjects:
Calibration
Clinical medicine
Clinical outcomes
Coronary vessels
Demographics
Heart surgery
Hospitals
Intensive care
Mortality
Patients
Probability
Variables
forecasting
coronary artery
mortality
cardiac surgery
bypass surgery
heart valve disease
anesthesia
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Summary:Despite its large diffusion and improvements in safety, the risks of complications after cardiac surgery remain high. Published predictive perioperative scores (EUROSCORE, STS, ACEF) assess risk on preoperative data only, not accounting for the intraopertive period. We propose a double-fold model, including data collected before surgery and data collected at the end of surgery, to evaluate patient risk evolution over time and assess the direct contribution of surgery. A total of 15,882 cardiac surgery patients from a Margherita-Prosafe cohort study were included in the analysis. Probability of death was estimated using two logistic regression models (preoperative data only vs. post-operative data, also including information at discharge from the operatory theatre), testing calibration and discrimination of each model. Pre-operative and post-operative models were built and demonstrate good discrimination and calibration with AUC = 0.81 and 0.87, respectively. Relative difference in pre- and post-operative mortality in separate centers ranged from -0.36 (95% CI: -0.44--0.28) to 0.58 (95% CI: 0.46-0.71). The usefulness of this two-fold preoperative model to benchmark medical care in single hospital is exemplified in four cases. Predicted post-operative mortality differs from predicted pre-operative mortality, and the distance between the two models represent the impact of surgery on patient outcomes. A double-fold model can assess the impact of the intra-operative team and the evolution of patient risk over time, and benchmark different hospitals on patients subgroups to promote an improvement in medical care in each center.
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ISSN:2077-0383
2077-0383
DOI:10.3390/jcm11113231