Derivation and validation of a clinical risk score to predict death among patients awaiting cardiac surgery in Ontario, Canada: a population-based study
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Key result
The CardiOttawa Waitlist Mortality Score predicted the likelihood of death while awaiting cardiac surgery with a C-statistic of 0.76 and excellent calibration across all procedure types.
Why the study?
Surgical delay may cause unintended harm or death in untreated cardiac surgery candidates, motivating a clinical score to predict waitlist mortality.
Population
112 266 patients aged 18 years or more referred for major cardiac surgery in Ontario
Design
Population-based retrospective cohort study for derivation and internal validation
Authors
Discussion
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Member takes
Implication
May support waitlist triage; leaves open external validation and prospective impact assessment before clinical adoption.
Study Design
Type
Cohort (n=112,266)
Multicenter
Yes
Structured PICO
P
Population
112,266 adult patients awaiting major cardiac surgery in Ontario, Canada, followed from waitlist acceptance to removal to derive and validate a mortality risk score.
E
Exposure
Derivation and internal validation of a clinical risk score (CardiOttawa Waitlist Mortality Score) using a hybrid modelling approach (random forest followed by backward stepwise logistic regression).
O
Outcome
All-cause mortality that occurred between the date of acceptance onto the waitlist and the date of removal from the waitlisthard clinical
Main Result
Effect estimate: C-statistic 0.76
The CardiOttawa Waitlist Mortality Score is a simple, validated clinical risk model that accurately predicts the likelihood of death while awaiting cardiac surgery, providing data-driven decision support for surgical triage.
Limitations
- Unable to include information on prescription medications for all patients
- Low event rates within each type of surgery precluded procedure-specific modelling
- Lacked detailed physiologic measures such as brain natriuretic peptide level
- Unable to account for nonlinearity of continuous variables or split cohort into derivation and validation samples
- Needs validation in the contemporary pandemic era to evaluate performance in the setting of prolonged wait times
- Inability to include information on prescription medications for all patients due to universal drug coverage being limited to residents aged ≥65 years
- Lack of detailed physiologic measures such as brain natriuretic peptide levels in the databases used
Cite This Study
Sun et al. (2022) conducted a cohort in Awaiting major cardiac surgery (n=112,266). Clinical risk factors (CardiOttawa Waitlist Mortality Score) was evaluated on All-cause mortality while on the waitlist (C-statistic 0.76). The CardiOttawa Waitlist Mortality Score predicted the likelihood of death while awaiting cardiac surgery with a C-statistic of 0.76 and excellent calibration across all procedure types.
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