Case-mix affects calibration of cardiosurgical severity scores.

Minerva anestesiologica
Anna ZamperoniCardiac surgical intensive care writing committee (GiViTI)

Abstract

Prognostic models are often used to assess the quality of healthcare. Several scores were developed to predict mortality after cardiac surgery, but none has reached optimal performance in subsequent validations. We validate the most used scores (EUROSCORE I and II, STS, and ACEF) on a cohort of cardiac-surgery patients, assessing their robustness against case-mix changes. The scores were validated on 14,559 patients admitted to 16 Italian cardiosurgical ICUs participating to Margherita-Prosafe project in 2014 and 2015. Calibration was assessed through Hosmer-Lemeshow Test, standardized mortality ratio, and GiViTI calibration test and belt. Discrimination was measured by the area under the ROC curve. The study included 10,317 patients who were eligible to the calculation of the STS Score (4156 isolated valve, 4681 isolated CABG and 1480 single valve and CABG) which calibrated well in these subgroups. The ACEF Score and EUROSCORE I and II were available for 14,139, and 14,071 patients, respectively. EUROSCORE I significantly overestimated mortality; EUROSCORE II calibrated well overall, but underestimated mortality of patients undergoing complex surgery and non-elective ones. The ACEF Score calibrated poorly in elective and non-e...Continue Reading

References

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Mar 5, 2011·PloS One·Stefano FinazziGuido Bertolini
Mar 2, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Samer A M NashefUlf Lockowandt
Jul 24, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Umberto Di DeddaMarco Ranucci
Mar 29, 2013·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Neil J HowellDomenico Pagano
Jan 10, 2014·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Fabio BariliAlessandro Parolari
Feb 1, 2014·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Domenico PaparellaTommaso Fiore
Jan 20, 2016·Journal of Cardiothoracic Surgery·Marco RanucciUNKNOWN Surgical and Clinical Outcome Research (SCORE) Group

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Citations

Apr 7, 2020·Minerva anestesiologica·Marco Ranucci
Dec 19, 2020·Minerva anestesiologica·Stefano FinazziUNKNOWN GiViTI-PROSAFE collaboration

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