Development of a Novel Society of Thoracic Surgeons Adult Congenital Mortality Risk Model
Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Operative mortality risk models for adults with congenital heart disease (ACHD) undergoing cardiac operations are essential, given the growing population of these patients, yet they are currently unavailable. Existing adult Society of Thoracic Surgeons (STS) models exclude congenital procedures, whereas existing congenital models exclude operations for acquired disease. We aimed to develop an STS mortality risk model for ACHD patients undergoing cardiac operations.
METHODS: Leveraging a comprehensive list of diagnostic and procedure codes, ACHD patients who underwent cardiac operations were identified from the STS Adult Cardiac Surgery Database (versions: v2.73, v2.81, and v2.9) between 2011 and 2019. The model was developed and validated in the ACHD population using a 60/40 development/validation split. Univariate analyses and clinical expertise informed the addition of ACHD-relevant procedure and diagnosis variables to existing STS adult risk model variables. Model performance was assessed overall and in 38 subgroups based on patient demographics, procedures, and diagnoses.
RESULTS: Forty-seven procedure and diagnosis variables relevant to ACHD were added to existing STS adult risk model variables. The derived ACHD model for operative mortality was well calibrated within demographic, procedural, and diagnosis subgroups and the overall ACHD population, and discrimination in the validation cohort was excellent (C statistic, 0.815) compared with the model using only existing STS adult risk model variables (C statistic, 0.79; P < .0001).
CONCLUSIONS: A novel, high-performing STS ACHD mortality risk model has been developed on the basis of contemporary patient data. The ACHD risk model represents an important expansion of the STS portfolio. Implementation with an online risk calculator is planned.
| Errataetall: |
CommentIn: Ann Thorac Surg. 2023 Aug;116(2):338-339. - PMID 37031767 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:116 |
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| Enthalten in: |
The Annals of thoracic surgery - 116(2023), 2 vom: 05. Aug., Seite 331-338 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nelson, Jennifer S [VerfasserIn] |
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| Anmerkungen: |
Date Completed 25.07.2023 Date Revised 25.07.2023 published: Print-Electronic CommentIn: Ann Thorac Surg. 2023 Aug;116(2):338-339. - PMID 37031767 Citation Status MEDLINE |
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| doi: |
10.1016/j.athoracsur.2023.01.015 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a CommentIn: Ann Thorac Surg. 2023 Aug;116(2):338-339. - PMID 37031767 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Operative mortality risk models for adults with congenital heart disease (ACHD) undergoing cardiac operations are essential, given the growing population of these patients, yet they are currently unavailable. Existing adult Society of Thoracic Surgeons (STS) models exclude congenital procedures, whereas existing congenital models exclude operations for acquired disease. We aimed to develop an STS mortality risk model for ACHD patients undergoing cardiac operations | ||
| 520 | |a METHODS: Leveraging a comprehensive list of diagnostic and procedure codes, ACHD patients who underwent cardiac operations were identified from the STS Adult Cardiac Surgery Database (versions: v2.73, v2.81, and v2.9) between 2011 and 2019. The model was developed and validated in the ACHD population using a 60/40 development/validation split. Univariate analyses and clinical expertise informed the addition of ACHD-relevant procedure and diagnosis variables to existing STS adult risk model variables. Model performance was assessed overall and in 38 subgroups based on patient demographics, procedures, and diagnoses | ||
| 520 | |a RESULTS: Forty-seven procedure and diagnosis variables relevant to ACHD were added to existing STS adult risk model variables. The derived ACHD model for operative mortality was well calibrated within demographic, procedural, and diagnosis subgroups and the overall ACHD population, and discrimination in the validation cohort was excellent (C statistic, 0.815) compared with the model using only existing STS adult risk model variables (C statistic, 0.79; P < .0001) | ||
| 520 | |a CONCLUSIONS: A novel, high-performing STS ACHD mortality risk model has been developed on the basis of contemporary patient data. The ACHD risk model represents an important expansion of the STS portfolio. Implementation with an online risk calculator is planned | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a O'Brien, Sean M |e verfasserin |4 aut | |
| 700 | 1 | |a Feins, Eric N |e verfasserin |4 aut | |
| 700 | 1 | |a Jacobs, Jeffrey P |e verfasserin |4 aut | |
| 700 | 1 | |a Mayer, John E |e verfasserin |4 aut | |
| 700 | 1 | |a Najm, Hani K |e verfasserin |4 aut | |
| 700 | 1 | |a Shahian, David M |e verfasserin |4 aut | |
| 700 | 1 | |a Hill, Kevin D |e verfasserin |4 aut | |
| 700 | 1 | |a Maul, Timothy M |e verfasserin |4 aut | |
| 700 | 1 | |a Habib, Robert H |e verfasserin |4 aut | |
| 700 | 1 | |a Bloom, Jordan P |e verfasserin |4 aut | |
| 700 | 1 | |a Karamlou, Tara |e verfasserin |4 aut | |
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