Key result
The British Aneurysm Repair score (C-statistic 0.83) and Vascular Biochemistry and Haematology Outcome Model (C-statistic 0.85) were the best performing mortality prediction models for AAA surgery.
Why the study?
Which mortality risk prediction models are most useful for patients undergoing abdominal aortic aneurysm repair?
Systematic Review (n=27)
Which mortality risk prediction models are most useful for patients undergoing abdominal aortic aneurysm repair?
Effect estimate: C-statistic 0.83 to 0.85
Existing mortality risk prediction models for AAA surgery have variable performance and lack external validation, suggesting that adapting case-mix correction to specific populations is preferable to developing new models.
Existing AAA mortality models lack robust external validation for routine use; leaves open whether population-adapted case-mix correction improves risk assessment.
BACKGROUND: The introduction of endovascular aneurysm repair (EVAR) has reduced perioperative mortality after abdominal aortic aneurysm (AAA) surgery. The objective of this systematic review was to assess existing mortality risk prediction models, and identify which are most useful for patients undergoing AAA repair by either EVAR or open surgical repair. METHODS: A systematic search of the literature was conducted for perioperative mortality risk prediction models for patients with AAA published since 2006. PRISMA guidelines were used; quality was appraised, and data were extracted and interpreted following the CHARMS guidelines. RESULTS: Some 3903 studies were identified, of which 27 were selected. A total of 13 risk prediction models have been developed and directly validated. Most models were based on a UK or US population. The best performing models regarding both applicability and discrimination were the perioperative British Aneurysm Repair score (C-statistic 0·83) and the preoperative Vascular Biochemistry and Haematology Outcome Model (C-statistic 0·85), but both lacked substantial external validation. CONCLUSION: Mortality risk prediction in AAA surgery has been modelled extensively, but many of these models are weak methodologically and have highly variable performance across different populations. New models are unlikely to be helpful; instead case-mix correction should be modelled and adapted to the population of interest using the relevant mortality predictors.
No takes yet. Share an insight, caveat, or question.
Lijftogt et al. (2017) conducted a systematic review in Abdominal aortic aneurysm (AAA) (n=27). Mortality risk prediction models was evaluated on Model performance (applicability and discrimination) for perioperative mortality (C-statistic 0.83 to 0.85). The British Aneurysm Repair score (C-statistic 0.83) and Vascular Biochemistry and Haematology Outcome Model (C-statistic 0.85) were the best performing mortality prediction models for AAA surgery.
Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context: