Validation of long‐term survival prediction for scheduled abdominal aortic aneurysm repair with an independent calculator using only pre‐operative variables

Carlisle, J. B.; Danjoux, Gerard; Kerr, Karen; Snowden, Christopher; Swart, Michael

doi:10.1111/anae.13061

Cited by 57 publications

(55 citation statements)

References 29 publications

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“…Simulated effect on survival of scheduled abdominal aortic aneurysm repair for the Torbay patient decile (34/302, solid lines) with the lowest monthly mortality hazard and the decile (29/302, dashed lines) with the highest monthly mortality hazard 4. The lines indicate survival with ( and ) and without surgery ( and ).…”

Section: Resultsmentioning

confidence: 99%

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Simulations of the effects of scheduled abdominal aortic aneurysm repair on survival

Carlisle

2015

Anaesthesia

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SummaryI simulated survival with and without scheduled repair of abdominal aortic aneurysms with different diameters in different populations. The results imply that scheduled repair should be determined by the combination of a patient's monthly mortality hazard and aneurysm diameter. The median survival of some patients will be extended by the scheduled repair of aneurysms smaller than 55 mm, whereas the median survival of other patients will be curtailed by repair of any aneurysm. The results also suggest that, on average, surveillance is futile: the effect of scheduled aneurysm repair on an individual's median survival did not change but the cohort effect diminished as patients died during surveillance. The results of the UK Small Aneurysm Study were reproduced in simulation and are compatible with the repair of aneurysms smaller than 55 mm diameter. Epidemiological simulations suggest that past randomised controlled trials underestimate the effect of aneurysm repair today.

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Section: Resultsmentioning

confidence: 99%

“…This paper uses the calculator validated in the companion paper of postoperative survival in nearly 1000 patients after scheduled repair of abdominal aortic aneurysms 4.…”

Section: Introductionmentioning

confidence: 99%

Simulations of the effects of scheduled abdominal aortic aneurysm repair on survival

Carlisle

2015

Anaesthesia

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“…In addition, they included factors such as cardiopulmonary exercise testing and aerobic fitness, both commonly used in preoperative assessments. 2 Our model uses a fairly simple risk score based on nearly all clinical factors.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, there are few validated risk scores against which to gauge the potential benefit of repair to assist clinicians in estimating the long-term survival of patients after AAA repair. 2 A previously developed risk prediction model for survival after AAA repair has been created using data from the Vascular Study Group of New England (VSGNE). 3 The purpose of our current study was to externally validate this risk prediction model in an independent group of patients.…”

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External validation of a 5-year survival prediction model after elective abdominal aortic aneurysm repair

DeMartino

Huang

Mandrekar³

et al. 2018

Journal of Vascular Surgery

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Objective The benefit of prophylactic repair of abdominal aortic aneurysms (AAAs) is based on the risk of rupture exceeding the risk of death from other comorbidities. The purpose of this study was to validate a 5-year survival prediction model for patients undergoing elective repair of asymptomatic AAA <6.5 cm to assist in optimal selection of patients. Methods All patients undergoing elective repair for asymptomatic AAA <6.5 cm (open or endovascular) from 2002 to 2011 were identified from a single institutional database (validation group). We assessed the ability of a prior published Vascular Study Group of New England (VSGNE) model (derivation group) to predict survival in our cohort. The model was assessed for discrimination (concordance index), calibration (calibration slope and calibration in the large), and goodness of fit (score test). Results The VSGNE derivation group consisted of 2367 patients (70% endovascular). Major factors associated with survival in the derivation group were age, coronary disease, chronic obstructive pulmonary disease, renal function, and antiplatelet and statin medication use. Our validation group consisted of 1038 patients (59% endovascular). The validation group was slightly older (74 vs 72 years; P < .01) and had a higher proportion of men (76% vs 68%; P < .01). In addition, the derivation group had higher rates of advanced cardiac disease, chronic obstructive pulmonary disease, and baseline creatinine concentration (1.2 vs 1.1 mg/dL; P < .01). Despite slight differences in preoperative patient factors, 5-year survival was similar between validation and derivation groups (75% vs 77%; P = .33). The concordance index of the validation group was identical between derivation and validation groups at 0.659 (95% confidence interval, 0.63–0.69). Our validation calibration in the large value was 1.02 (P = .62, closer to 1 indicating better calibration), calibration slope of 0.84 (95% confidence interval, 0.71–0.97), and score test of P = .57 (>.05 indicating goodness of fit). Conclusions Across different populations of patients, assessment of age and level of cardiac, pulmonary, and renal disease can accurately predict 5-year survival in patients with AAA <6.5 cm undergoing repair. This risk prediction model is a valid method to assess mortality risk in determining potential overall survival benefit from elective AAA repair.

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“…I have used a calculator, which modifies general population survival, to generate accurate projected survival after repair of intact abdominal aneurysms, after cardiac surgery and after resection of colorectal cancer (I win) [2][3][4][5][6]. I have used a calculator, which modifies general population survival, to generate accurate projected survival after repair of intact abdominal aneurysms, after cardiac surgery and after resection of colorectal cancer (I win) [2][3][4][5][6].…”

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confidence: 99%

Discounting risk prediction models – a reply

Carlisle

2019

Anaesthesia

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Validation of long‐term survival prediction for scheduled abdominal aortic aneurysm repair with an independent calculator using only pre‐operative variables

Cited by 57 publications

References 29 publications

Simulations of the effects of scheduled abdominal aortic aneurysm repair on survival

Simulations of the effects of scheduled abdominal aortic aneurysm repair on survival

External validation of a 5-year survival prediction model after elective abdominal aortic aneurysm repair

Discounting risk prediction models – a reply

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