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European Journal of Cardio-Thoracic Surgery, Vol 11, 415-423, Copyright © 1997 by European Association for Cardio-thoracic Surgery
JM Pons, A Granados, JA Espinas, JM Borras, I Martin and V Moreno
OBJECTIVE: To develop a risk stratification model to assess open heart
surgery mortality in Catalonia (Spain) in order to use risk-adjusted
hospital mortality rates as an approach to analyze quality of care.
METHODS: Data were prospectively collected through a specific data- sheet
during 6 1/2 months in consecutive adult patients subjected to open heart
surgery. The dependent variable was surgical mortality, and independent
variables included were presurgical (sociodemographic data, clinical
antecedents, morphological and functional studies) and surgical. The model
was built on a subsample (70% of study population) through univariate and
logistic regression analysis and validated in the rest of the sample.
RESULTS: The total sample was of 1309 procedures in seven hospitals; 47% of
them were valve procedures. The overall crude mortality rate was 10.9% and
varied among centers (range, 2.8-14.8%). Risk factors included in the model
received a weight based on the logistic regression coefficient and a score
was generated for each patient. The factors with the highest weight were
patient older than 80 and second reoperation. Score was stratified in five
categories of increasing risk. There was a good agreement between observed
and predicted mortality rates in the validation group. Overall patient
distribution was as follows: 52% low risk level, 16% fair, 13% high, 12%
very high, and 6% extremely high risk level. Mortality rate increased from
4.2% in the low risk to 54.4% in the highest risk group. Case mix
adjustment was performed through the risk score level. There were
statistically significant differences in the risk profiles of patients
admitted among centers. After adjustment by risk profiles, there were no
differences in mortality by hospital. CONCLUSION: A risk stratification
model through a multicentric, prospective and exhaustive collection of data
in all types of open heart procedures was developed. In spite of wide
differences on crude rates and in the risk profiles of patients admitted,
we did not find statistically significant differences in adjusted mortality
rates among centers. Timely and accurate information about surgical
outcomes can lead to improvements in clinical practice and quality of care.
ARTICLES
Assessing open heart surgery mortality in Catalonia (Spain) through a predictive risk model
Catalan Agency for Health Technology Assessment (Agencia d'Avaluacio de Tecnologia Medica), Barcelona, Spain.
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