Risk-adjusted predictive models of mortality after index arterial operations using a minimal data set

Prytherch, David; Ridler, B. M. F.; Ashley, S.

doi:10.1002/bjs.4965

Cited by 29 publications

(27 citation statements)

References 7 publications

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“…This can be done with mathematical outcomes models that quantify risk based on easily recordable data. 36 The Vascular Biochemistry and Hematology Outcome Models (VBHOM) attempts to identify a minimal objective data set that can predict outcome following vascular interventions. 37,38 Tang et al determined from a derivation and validation set that gender, mode of admission, age, urea, sodium, potassium, hemoglobin, WBC, creatinine, and urea/creatinine successfully predicted surgical mortality.…”

Section: Discussionmentioning

confidence: 99%

Normal preoperative white blood cell count is predictive of outcomes for endovascular procedures

Amaranto

Wang

Eskandari

et al. 2011

Journal of Vascular Surgery

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This study demonstrates a strong linear correlation between an increasing preoperative WBC within the normal range and an increased risk for postoperative complications and death following endovascular interventions. The study also found a significant curvilinear U-shaped relation between a normal preoperative WBC and death in the open surgical cohort, with patients in the very low and very high normal WBC range at an increased risk of death.

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Section: Discussionmentioning

confidence: 99%

Normal preoperative white blood cell count is predictive of outcomes for endovascular procedures

Amaranto

Wang

Eskandari

et al. 2011

Journal of Vascular Surgery

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“…The improvement in the observed mortality was large (21 down to 5%), but after adjusting for the V-POSSUM scores, the improvement attributable to the surgeon was approximately 50% (the observed over expected ratios averaged approximately 50% for periods [8][9][10][11].…”

Section: Resultsmentioning

confidence: 94%

“…A recently reported minimum dataset for vascular surgery (Vascular Biochemistry and Haematology Outcome Models) only uses information obtainable before operation and would be easier to collect routinely than V-POSSUM. [9][10][11] This has several advantages if supported by further studies. It would enable collection of data in 1-2 min and this could be automated from computer records, which would facilitate regular updating of performance.…”

Section: Discussionmentioning

confidence: 90%

Evaluation of Surgical Performance Using V‐possum Risk‐adjusted Mortality Rates

Mosquera

Chiang

Gibberd

2008

ANZ Journal of Surgery

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Vascular-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (V-POSSUM) is a risk-adjusted scoring system for predicting 30-day mortality in patients undergoing vascular surgery. It can assess surgical performance by comparing predicted deaths with observed deaths. The aim of this analysis was to assess trends in surgical performance over time using risk-adjusted 30-day mortality as the primary outcome. Major vascular surgery procedures (n = 454) were prospectively scored for V-POSSUM between 1995 and 2006. Procedures were divided into 11 consecutive time bands. Observed and predicted deaths were compared using the logistic regression equation derived for V-POSSUM. The observed death rates decreased over time, as did the predicted number of deaths calculated from the V-POSSUM scores. The overall predicted mortality rate was 17.2% and the rate varied with the 12-month period, with a high of 23.9% and a low of 9.2%. The downward trend in the predicted rate shows that the patient risk factors have changed over time and that the risk of dying has declined by almost 50% (from 21.6 to 11.1%). There was a trend towards improved surgical performance over time, with a drop in the observed to predicted ratios of deaths. Observed and predicted deaths changed over the study periods. There was a trend towards improved performance compared with the risk-adjusted predicted mortality. V-POSSUM is a useful tool in the longitudinal assessment of performance in major vascular surgery.

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“…The BUPA operative severity score is used in the private sector (UK) as an indicator of surgical complexity and workload. The BHOM uses information which is easily obtainable from most hospital information technology systems to calculate predictive mortalities 69 70. As previously stated, a risk assessment scoring system should ideally have few variables, which are simple to collate and therefore make the score easy to implement in daily practice.…”

Section: Biochemical and Haematological Outcome Modelsmentioning

confidence: 99%

Clinical risk scores to guide perioperative management

Barnett

Moonesinghe²

2011

Postgraduate Medical Journal

109

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Perioperative morbidity is associated with reduced long term survival. Comorbid disease, cardiovascular illness, and functional capacity can predispose patients to adverse surgical outcomes. Accurate risk stratification would facilitate informed patient consent and identify those individuals who may benefit from specific perioperative interventions. The ideal clinical risk scoring system would be objective, accurate, economical, simple to perform, based entirely on information available preoperatively, and suitable for patients undergoing both elective and emergency surgery. The POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) scoring systems are the most widely validated perioperative risk predictors currently utilised; however, their inclusion of intra- and postoperative variables precludes validation for preoperative risk prediction. The Charlson Index has the advantage of consisting exclusively of preoperative variables; however, its validity varies in different patient cohorts. Risk models predicting cardiac morbidity have been extensively studied, despite the relatively uncommon occurrence of postoperative cardiac events. Probably the most widely used cardiac risk score is the Lee Revised Cardiac Risk Index, although it has limited validity in some patient populations and for non-cardiac outcomes. Bespoke clinical scoring systems responding to dynamic changes in population characteristics over time, such as those developed by the American College of Surgeons National Surgical Quality Improvement Program, are more precise, but require considerable resources to implement. The combination of objective clinical variables with information from novel techniques such as cardiopulmonary exercise testing and biomarker assays, may improve the predictive precision of clinical risk scores used to guide perioperative management.

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Risk-adjusted predictive models of mortality after index arterial operations using a minimal data set

Abstract: A 'data economic' model for risk stratification of national data is feasible. The ability to use a minimal data set may facilitate the process of comparative audit within the NVD.

Cited by 29 publications

References 7 publications

Normal preoperative white blood cell count is predictive of outcomes for endovascular procedures

Normal preoperative white blood cell count is predictive of outcomes for endovascular procedures

Evaluation of Surgical Performance Using V‐possum Risk‐adjusted Mortality Rates

Clinical risk scores to guide perioperative management

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