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Does the choice of risk adjustment model influence the outcome of surgeon specific mortality analysis: a retrospective analysis of 14,637 patients under 31 surgeons
  1. Stuart W Grant
  1. University Hospital of South Manchester NHS Foundation Trust, United Kingdom
    1. Antony D Grayson (tony.grayson{at}ctc.nhs.uk)
    1. The Cardiothoracic Centre, United Kingdom
      1. Mark Jackson (mark.jackson{at}ctc.nhs.uk)
      1. The Cardiothoracic Centre, United Kingdom
        1. John Au
        1. Blackpool Victoria Hospital, United Kingdom
          1. Brian M Fabri
          1. The Cardiothoracic Centre, United Kingdom
            1. Geir Grotte
            1. Manchester Royal Infirmary, United Kingdom
              1. Mark Jones
              1. University Hospital of South Manchester NHS Foundation Trust, United Kingdom
                1. Ben Bridgewater (ben.bridgewater{at}smuht.nwest.nhs.uk)
                1. University Hospital of South Manchester NHS Foundation Trust, United Kingdom

                  Abstract

                  Objectives To compare implications of using the logistic EuroSCORE and a locally derived model when analysing individual surgeon mortality outcomes.

                  Design Retrospective analysis of prospectively collected data.

                  Setting All NHS hospitals undertaking adult cardiac surgery in Northwest England.

                  Patients 14,637 consecutive patients, April 2002 to March 2005.

                  Main outcome measures We have compared the predictive ability of the logistic EuroSCORE (un-calibrated), the logistic EuroSCORE calibrated for contemporary performance and a locally derived logistic regression model. We have used each to create risk-adjusted individual surgeon mortality funnel plots to demonstrate high mortality outcomes.

                  Results There were 458 (3.1%) deaths. The expected mortality and ROC curve values were: un-calibrated EuroSCORE - 5.8% and 0.80, calibrated EuroSCORE - 3.1% and 0.80, locally derived model - 3.1% and 0.82. The un-calibrated EuroSCORE plot showed one surgeon to have mortality above the Northwest average, and no surgeon above the 95% CL. The calibrated EuroSCORE plot and the local model showed little change in surgeon ranking, however are significant differences in identifying high mortality outcomes. Two of three surgeons above the 95% CL using the calibrated EuroSCORE revert to acceptable outcomes when the local model is applied but the finding is critically dependent on the calibration coefficient.

                  Conclusions The un-calibrated EuroSCORE significantly over-predicted mortality and is not recommended. Instead, the EuroSCORE should be calibrated for contemporary performance. The differences demonstrated in defining high mortality outcomes when using a model built for purpose suggests that the choice of risk model is important when analysing surgeon mortality outcomes.

                  • Cardiac surgery
                  • EuroSCORE
                  • Risk adjustment
                  • Surgeon specific mortality

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