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• W1992173631 abstract "Background: Risk models are useful tools for computing risk-adjusted outcomes. However, the models are only as good as the data on which they are based and therefore have limitations. Our aim was to compare the abilities of surgeons and an established risk model to predict operative mortality after aortic valve replacement (AVR). We also investigated scenarios that give rise to discrepancies between surgeons' and the risk model's predictions. Methods: The Veterans Affairs Continuous Improvement in Cardiac Surgery Program (CICSP) is a prospective database and a well-validated cardiac surgery risk model. Before surgery, surgeons are asked to use their experience and judgment to estimate each patient's mortality risk, and this estimate is recorded in the database. We reviewed all AVR procedures performed at a single Veterans Affairs institution between October 1993 and October 2008 (total, n=317; primary isolated AVRs, n=163). The ability of the CICSP risk model and the surgeons to predict operative mortality was assessed by the area under the receiver operating characteristic curve (AUC). The method of Hanley and McNeil was used to test for differences in the c-statistics between the 2 models. We investigated the cases in which there was a significant discrepancy (2-fold or greater) between the surgeons' and the risk model's predictions. Results: The predictive abilities of both the surgeons and the CICSP risk model were good, with AUC values of 0.73 and 0.75, respectively (P=0.84). However, the surgeons' mean estimate of operative mortality (8.3%±8.3%) exceeded both the CICSP's estimate (6.6%±8.3%) (paired t-test P<0.0001) and the actual mortality rate of 5.4% (17 of 317). There was a significant discrepancy between the surgeon's risk estimate and that of the CICSP model in 38% (122/317) of cases. In 33% (40/122) of cases of significant discrepancy, the CICSP model did not incorporate in its mortality calculation factors that were identified by the surgeon as potential predictors of mortality; the most common of these were anticipating a more extensive procedure (n=7), severe pulmonary disease other than chronic obstructive pulmonary disease (n=5), hepatic disease (n=5), and pulmonary hypertension (n=5). Conclusions: Both surgeons and the CICSP risk model performed well in predicting operative mortality in a cohort of AVR patients. The CICSP did not capture some disease entities of concern to the surgeon when considering individual/patient-specific mortality risk. However, the surgeons tended to overestimate mortality risk." @default.
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• W1992173631 date "2010-02-01" @default.
• W1992173631 modified "2023-10-16" @default.
• W1992173631 title "Operative Mortality after Aortic Valve Replacement: Predictions Made by Surgeons versus Risk Model" @default.
• W1992173631 doi "https://doi.org/10.1016/j.jss.2009.11.151" @default.
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