Key result
Actual cardiac surgical mortality was 4.2% compared to a predicted mortality of 10.2% by Parsonnet score, with the mortality ratio varying widely across risk groups and individual surgeons.
Why the study?
Does the relationship between predicted and actual cardiac surgical mortality vary consistently across risk groups and individual surgeons in adult patients undergoing cardiac surgery?
Observational (n=6,213)
No
Does the relationship between predicted and actual cardiac surgical mortality vary consistently across risk groups and individual surgeons in adult patients undergoing cardiac surgery?
Effect estimate: mortality ratio 41%
Absolute Event Rate: 10.2% vs 4.2%
The accuracy of predicted cardiac surgical mortality varies significantly depending on the patient's risk group and the individual surgeon, highlighting the need for personalized preoperative risk assessment.
Parsonnet score overestimates mortality with wide variation by risk group and surgeon; leaves open whether individualized models improve preoperative risk assessment.
OBJECTIVE: To study the relationship between predicted and actual mortality in a cardiac surgical practice and to determine whether there is a consistent relationship across risk groups and surgeons. METHODS: Risk information (Parsonnet score) was prospectively collected for 6213 consecutive adult patients undergoing cardiac surgery at one institution. The relationship between predicted mortality and actual mortality was analysed by risk group for all patients and for individual surgeons' practices. RESULTS: Predicted mortality was 10.2%. Actual mortality was 4.2%, giving a mortality ratio of 41% of predicted. This ratio was not consistent across the five major risk groups, ranging from 32% in moderate risk to 67% in very low risk patients. When analysed by individual surgical practices, the results were even more disparate, with a mortality index range between 0% for one surgeon's low risk patients to 150% for another surgeon's very low risk patients. CONCLUSION: The relationship between predicted and actual mortality at one institution may vary across the risk spectrum and between surgeons. This should be taken into account in preoperative risk assessment and informed patient consent. Individual surgeons may have strengths and weaknesses which are related to preoperative risk stratification.
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Nashef et al. (2001) conducted an observational in Cardiac surgery (n=6,213). Parsonnet score was evaluated on Mortality (mortality ratio 41%). Actual cardiac surgical mortality was 4.2% compared to a predicted mortality of 10.2% by Parsonnet score, with the mortality ratio varying widely across risk groups and individual surgeons.
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