How Accurate Is the Eyeball Test?

Jain, Renuka; Duval, Sue; Adabag, Selçuk

doi:10.1161/circoutcomes.113.000329

Cited by 54 publications

(31 citation statements)

References 37 publications

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“…In cardiac surgery, surgeons rarely classified individuals as low risk even when they were 19,37,49 . Surgeons' predictions of mortality in both general and cardiac surgery were good, with most of the AUCs presented in papers being greater than 0⋅7.…”

Section: Discussionmentioning

confidence: 99%

“…Where data were presented, surgeons consistently overestimated mortality risk. It is been suggested that the pessimism in predictions may allow patients to exceed surgeons' expectations (when pessimistic predictions are proven wrong), which is psychologically preferable to patients failing to meet a pre-established expectation 37 . In cardiac surgery, surgeons rarely classified individuals as low risk even when they were 19,37,49 .…”

Section: Discussionmentioning

confidence: 99%

“…In six of seven studies assessing mortality estimate, surgeons (range 0⋅68-0⋅91) were outperformed by risk prediction tools (range 0⋅64-0⋅98). In cardiac surgery, surgeons rarely classified individuals as low risk, even when they were 19,37,49 . Both surgeons and anaesthetists assessed risk, with anaesthetists (O : E ratio 0⋅93; AUC 0⋅907) performing marginally better than surgeons (O : E ratio 0⋅83; AUC = 0⋅903).…”

Section: Baseline Characteristics and Study Designmentioning

confidence: 99%

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Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

et al. 2020

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Background: The accuracy with which surgeons can predict outcomes following surgery has not been explored in a systematic way. The aim of this review was to determine how accurately a surgeon's 'gut feeling' or perception of risk correlates with patient outcomes and available risk scoring systems.Methods: A systematic review was undertaken in accordance with PRISMA guidelines. A narrative synthesis was performed in accordance with the Guidance on the Conduct of Narrative Synthesis In Systematic Reviews. Studies comparing surgeons' preoperative or postoperative assessment of patient outcomes were included. Studies that made comparisons with risk scoring tools were also included. Outcomes evaluated were postoperative mortality, general and operation-specific morbidity and long-term outcomes.Results: Twenty-seven studies comprising 20 898 patients undergoing general, gastrointestinal, cardiothoracic, orthopaedic, vascular, urology, endocrine and neurosurgical operations were included. Surgeons consistently overpredicted mortality rates and were outperformed by existing risk scoring tools in six of seven studies comparing area under receiver operating characteristic (ROC) curves (AUC).Surgeons' prediction of general morbidity was good, and was equivalent to, or better than, pre-existing risk prediction models. Long-term outcomes were poorly predicted by surgeons, with AUC values ranging from 0⋅51 to 0⋅75. Four of five studies found postoperative risk estimates to be more accurate than those made before surgery.Conclusion: Surgeons consistently overestimate mortality risk and are outperformed by pre-existing tools; prediction of longer-term outcomes is also poor. Surgeons should consider the use of risk prediction tools when available to inform clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Baseline Characteristics and Study Designmentioning

confidence: 99%

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Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

et al. 2020

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“…The database includes information regarding patient demographics, clinical and laboratory variables, surgical details, and post-operative outcomes, including long-term survival (11,12). Additional clinical, pharmacologic, and echocardiographic variables, that were not included in the database, were extracted from electronic medical records (13).…”

Section: Data Sourcementioning

confidence: 99%

Effect of coronary artery bypass graft surgery on left ventricular systolic function

Koene¹,

Kealhofer²,

Adabag³

et al. 2017

J. Thorac. Dis.

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consecutive patients underwent isolated CABG at the Minneapolis Veterans Affairs Health Care System. Of these, 375 had echocardiographic assessment of LV function before (within 6 months) and after (3 to 24 months) CABG and were included in this analysis. Results: While the mean LV ejection fraction (LVEF) did not change following CABG [(49±13)% vs.(49±12)%, P=0.51], LVEF decreased in the subgroup with normal (≥50%) pre-operative LVEF [from (59±5)% to (56±9)%, P<0.001] and improved in those with decreased (<50%) pre-operative LVEF [from (36±9)% to (41±12)%, P<0.001]. There was a significant reduction in LV internal diameter during end-diastole (LVIDd) (5.4±0.8 vs. 5.3±0.9, P=0.002) and an increase in left atrial diameter (LAD) (4.4±0.7 vs. 4.6±0.7, P<0.001).There were no perioperative changes in LV internal diameter during end-systole, LV mass, posterior wall thickness, or septal wall thickness. LVEF improved by >5% in 24% of the study population, did not change (+/− 5%) in 55%, and worsened by >5% in 21%. Patients with improved EF were less often diabetic and had lower pre-operative LVEF, and greater LV dimensions at baseline. Conclusions: After CABG, there was a decrease in LVIDd and an increase in LAD. Also, a decrease in LV systolic function with CABG was observed in patients with normal pre-operative LVEF and an improvement in LV systolic function was observed in patients with decreased pre-operative LVEF. The effect of CABG on LV systolic function remains to be elucidated. While the STICH trial evaluated the effect of CABG in patients with severe LV dysfunction (EF ≤35%), to our knowledge, no large studies have assessed the effect of CABG on LV parameters in patients with normal baseline EF. The STICH trial showed a significant decrease in end-systolic volume index (ESVI) in patients with a baseline LV ESVI >90 mL/m 2 (10), while no significant change in LV ESVI was observed in the subgroups of patients with smaller LV cavity size (10). While LVEF significantly improved in patients with a baseline LV ESVI ≥60 mL/m 2 , no significant improvement in LVEF was seen in those with a baseline LV ESVI <60 mL/m 2 . The objectives of this study were to evaluate the effect of CABG on LV systolic function in patients with both normal and abnormal pre-operative systolic function. Methods Data sourceThe cardiac surgery database at the Minneapolis Veterans Affairs (VA) Health Care System is part of an ongoing multicenter database of prospectively collected data on all patients undergoing cardiac surgery at VA Medical Centers in the United States. The database includes information regarding patient demographics, clinical and laboratory variables, surgical details, and post-operative outcomes, including long-term survival (11,12). Additional clinical, pharmacologic, and echocardiographic variables, that were not included in the database, were extracted from electronic medical records (13). This study was approved by the Institutional Review Board at the Minneapolis VA Health Care System (No. 3949-B). Study patientsAdult pa...

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“…In clinical practice, experienced surgeons and cardiologists pragmatically and informally estimate individual risk based on their experience, clinical intuition, and judgment . However, robust research methodology mandates validated assessments that objectively predict the probability that a patient will develop an adverse outcome, so as to allow for appraisal of procedural efficacy.…”

Section: Discussionmentioning

confidence: 99%

Neurological Injury in Intermediate‐Risk Transcatheter Aortic Valve Implantation

Fanning

Wesley

Walters

et al. 2016

JAHA

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BackgroundThe application of transcatheter aortic valve implantation (TAVI) to intermediate‐risk patients is a controversial issue. Of concern, neurological injury in this group remains poorly defined. Among high‐risk and inoperable patients, subclinical injury is reported on average in 75% undergoing the procedure. Although this attendant risk may be acceptable in higher‐risk patients, it may not be so in those of lower risk.Methods and ResultsForty patients undergoing TAVI with the Edwards SAPIEN‐XT ™ prosthesis were prospectively studied. Patients were of intermediate surgical risk, with a mean±standard deviation Society of Thoracic Surgeons score of 5.1±2.5% and a EuroSCORE II of 4.8±2.4%; participant age was 82±7 years. Clinically apparent injury was assessed by serial National Institutes of Health Stroke Scale assessments, Montreal Cognitive Assessments (MoCA), and with the Confusion Assessment Method. These identified 1 (2.5%) minor stroke, 1 (2.5%) episode of postoperative delirium, and 2 patients (5%) with significant postoperative cognitive dysfunction. Subclinical neurological injury was assessed using brain magnetic resonance imaging, including diffusion‐weighted imaging (DWI) sequences preprocedure and at 3±1 days postprocedure. This identified 68 new DWI lesions present in 60% of participants, with a median±interquartile range of 1±3 lesions/patient and volumes of infarction of 24±19 μL/lesion and 89±218 μL/patient. DWI lesions were associated with a statistically significant reduction in early cognition (mean ΔMoCA −3.5±1.7) without effect on cognition, quality of life, or functional capacity at 6 months.ConclusionsObjectively measured subclinical neurological injuries remain a concern in intermediate‐risk patients undergoing TAVI and are likely to manifest with early neurocognitive changes.Clinical Trial Registration URL: http://www.anzctr.org.au. Australian & New Zealand Clinical Trials Registry: ACTRN12613000083796.

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How Accurate Is the Eyeball Test?

Cited by 54 publications

References 37 publications

Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

Effect of coronary artery bypass graft surgery on left ventricular systolic function

Neurological Injury in Intermediate‐Risk Transcatheter Aortic Valve Implantation

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