The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation SCORE for Predicting Mortality | Journal Scan

Study Questions:

Is the Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) a reliable risk model for in-hospital mortality after intervention for abdominal aortic aneurysm (AAA)?

Methods:

Using data collected during a 15-month period in the United Kingdom National Vascular Database, a multiple imputation methodology was applied, together with stepwise model selection, to generate preoperative and perioperative models of in-hospital mortality after AAA repair. Two thirds of the available data were used to develop the model, and model performance then was assessed using the remaining one third of the data by receiver operating characteristic curve analysis, and compared with existing risk prediction models. Model calibration was assessed by Hosmer-Lemeshow analysis.

Results:

A total of 8,088 AAA repair operations were recorded in the National Vascular Database during the study period, of which 5,870 (72.6%) were elective procedures. Both preoperative and perioperative models showed excellent discrimination, with areas under the receiver operating characteristic curve of 0.89 and 0.92, respectively. This was significantly better than any of the existing models (area under the receiver operating characteristic curve for best comparator model 0.84 and 0.88; p < 0.001 and p = 0.001, respectively). Discrimination remained excellent when only elective procedures were considered. There was no evidence of miscalibration by Hosmer-Lemeshow analysis.

Conclusions:

These appear to be accurate models to assess risk of in-hospital mortality after AAA repair. The models were carefully developed with rigorous statistical methodology, and significantly outperform existing methods for both elective cases and overall AAA mortality. The authors concluded that these models will be invaluable for both preoperative patient counseling and accurate risk adjustment of published outcome data.

Perspective:

Current risk prediction models for AAA repair might be suboptimal. The developed model appears to provide accurate assessment of risk for preoperative patient counseling, and for adjustment of surgical outcome data pertinent to surgeon-level reporting of outcomes.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and Vascular Medicine

Keywords: Aortic Aneurysm, Abdominal, Calibration, Counseling, Cardiac Surgical Procedures, ROC Curve, Risk, Risk Adjustment, Risk Assessment, Surgeons, Surgical Procedures, Elective, Primary Prevention


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