What is the clinical evidence from this study?

Study design: Observational. Population: Cardiac surgery (n=46883). Intervention: Hospital ranking lists based on mortality rates. Primary outcome: Precision of and fluctuations in ranking lists for cardiac surgery mortality rates.

What does this research mean for the field?

Hospital ranking lists based on cardiac surgery mortality rates are statistically imprecise and exhibit substantial reshuffling driven largely by chance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine the statistical precision and temporal fluctuations of hospital ranking lists used to compare cardiac surgery mortality rates.

May 1, 2012Circulation Cardiovascular Quality and OutcomesOpen Access

Limitations of Ranking Lists Based on Cardiac Surgery Mortality Rates

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Key result

Hospital cardiac surgery mortality rankings are imprecise and randomly reshuffle across ~8 ranks.

n=46,883

Why the study?

Ranking lists are commonly used to report cardiac surgery performance, but their precision and the extent of fluctuations in rankings are unknown.

Are ranking lists based on cardiac surgery mortality rates a precise method for comparing hospital performance?

Population

46,883 adult cardiac surgery patients in all 16 cardiothoracic centers in The Netherlands from 2007 to 2009

Comparison

Hospital ranking based on crude vs adjusted mortality rates using logistic EuroSCORE

Design

Observational study using random effects logistic regression model

Authors

SSSabrina SiregarErasmus MC RGRolf H. H. GroenwoldLuminex (United States)EJEvert K. JansenAmsterdam Neuroscience

Discussion

Member takes

Implication

Mortality rankings for cardiac surgery show large CI overlap and imprecision; challenges their use for hospital comparisons and leaves open reliable alternatives.

Key Points

To determine the statistical precision and temporal fluctuations of hospital ranking lists used to compare cardiac surgery mortality rates.
Extracted registry data for all adult cardiac surgery patients across all 16 cardiothoracic centers in the Netherlands between January 1, 2007, and December 31, 2009 (N=46,883).
Calculated hospital ranks for crude and risk-adjusted mortality using a random effects logistic regression model with the logistic EuroSCORE, alongside subgroup analysis for isolated coronary artery bypass grafting.
Assessed the statistical precision and annual stability of ranks over 3 consecutive years using 95% confidence intervals.
Hospital ranking lists demonstrated considerable reshuffling across consecutive years due to random statistical fluctuation.
The mean width of the 95% confidence intervals was 10 ranks for crude mortality rates and 8 ranks for risk-adjusted mortality rates across the 16 hospitals.
Substantial overlap in 95% confidence intervals among centers indicated ranks were not statistically distinguishable, with identical patterns observed in the isolated coronary artery bypass grafting subgroup.

Study Design

Type

Observational (n=46,883)

Multicenter

Yes

Structured PICO

Are ranking lists based on cardiac surgery mortality rates a precise method for comparing hospital performance?

Population

46,883 adult cardiac surgery patients across 16 centers in The Netherlands evaluated over 3 consecutive years to assess mortality rate rankings.

Exposure

Hospital ranking based on crude and adjusted mortality rates (risk adjustment using logistic EuroSCORE)

Outcome

Precision of and fluctuations in ranking lists (assessed via 95% confidence intervals of ranks)

Ranking lists for cardiac surgery mortality are statistically imprecise and prone to random fluctuation, making them unreliable for comparing hospital performance.

Cite This Study

Siregar et al. (2012) conducted an observational in Cardiac surgery (n=46,883). Hospital ranking lists based on mortality rates was evaluated on Precision of and fluctuations in ranking lists for cardiac surgery mortality rates. Hospital ranking lists based on cardiac surgery mortality rates are imprecise, with a mean 95% confidence interval width of 8 ranks for adjusted mortality rates, leading to random reshuffling.

synapsesocial.com/papers/6aa8f60fb7c808b8b5d91de9 https://doi.org/10.1161/circoutcomes.111.964460

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Implication

Mortality rankings for cardiac surgery show large CI overlap and imprecision; challenges their use for hospital comparisons and leaves open reliable alternatives.

Limitations of Ranking Lists Based on Cardiac Surgery Mortality Rates

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Limitations of Ranking Lists Based on Cardiac Surgery Mortality Rates

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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