PMID- 15172248
OWN - NLM
STAT- MEDLINE
DCOM- 20040629
LR  - 20041117
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 77
IP  - 6
DP  - 2004 Jun
TI  - Multivariable prediction of in-hospital mortality associated with aortic and 
      mitral valve surgery in Northern New England.
PG  - 1966-77
AB  - BACKGROUND: Predicting risk for aortic and mitral valve surgery is important both 
      for informed consent of patients and objective review of surgical outcomes. 
      Development of reliable prediction rules requires large data sets with 
      appropriate risk factors that are available before surgery. METHODS: Data from 
      eight Northern New England Medical Centers in the period January 1991 through 
      December 2001 were analyzed on 8943 heart valve surgery patients aged 30 years 
      and older. There were 5793 cases of aortic valve replacement and 3150 cases of 
      mitral valve surgery (repair or replacement). Logistic regression was used to 
      examine the relationship between risk factors and in-hospital mortality. RESULTS: 
      In the multivariable analysis, 11 variables in the aortic model (older age, lower 
      body surface area, prior cardiac operation, elevated creatinine, prior stroke, 
      New York Heart Association [NYHA] class IV, congestive heart failure [CHF], 
      atrial fibrillation, acuity, year of surgery, and concomitant coronary artery 
      bypass grafting) and 10 variables in the mitral model (female sex, older age, 
      diabetes, coronary artery disease, prior cerebrovascular accident, elevated 
      creatinine, NYHA class IV, CHF, acuity, and valve replacement) remained 
      independent predictors of the outcome. The mathematical models were highly 
      significant predictors of the outcome, in-hospital mortality, and the results are 
      in general agreement with those of others. The area under the receiver operating 
      characteristic curve for the aortic model was 0.75 (95% confidence interval [CI], 
      0.72 to 0.77), and for the mitral model, 0.79 (95% CI, 0.76 to 0.81). The 
      goodness-of-fit statistic for the aortic model was chi(2) [8 df] = 11.88, p = 
      0.157, and for the mitral model it was chi(2) [8 df] = 5.45, p = 0.708. 
      CONCLUSIONS: We present results and methods for use in day-to-day practice to 
      calculate patient-specific in-hospital mortality after aortic and mitral valve 
      surgery, by the logistic equation for each model or a simple scoring system with 
      a look-up table for mortality rate.
FAU - Nowicki, Edward R
AU  - Nowicki ER
AD  - Dartmouth Medical School, Hanover, New Hampshire 03756, USA.
FAU - Birkmeyer, Nancy J O
AU  - Birkmeyer NJ
FAU - Weintraub, Ronald W
AU  - Weintraub RW
FAU - Leavitt, Bruce J
AU  - Leavitt BJ
FAU - Sanders, John H
AU  - Sanders JH
FAU - Dacey, Lawrence J
AU  - Dacey LJ
FAU - Clough, Robert A
AU  - Clough RA
FAU - Quinn, Reed D
AU  - Quinn RD
FAU - Charlesworth, David C
AU  - Charlesworth DC
FAU - Sisto, Donato A
AU  - Sisto DA
FAU - Uhlig, Paul N
AU  - Uhlig PN
FAU - Olmstead, Elaine M
AU  - Olmstead EM
FAU - O'Connor, Gerald T
AU  - O'Connor GT
CN  - Northern New England Cardiovascular Disease Study Group and the Center for 
      Evaluative Clinical Sciences, Dartmouth Medical School
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Analysis of Variance
MH  - Aortic Valve/*surgery
MH  - Area Under Curve
MH  - Cardiac Surgical Procedures/*mortality
MH  - Coronary Artery Bypass
MH  - Female
MH  - Heart Valve Prosthesis Implantation/mortality
MH  - *Hospital Mortality
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Models, Statistical
MH  - Multivariate Analysis
MH  - New England/epidemiology
MH  - ROC Curve
MH  - Risk Factors
EDAT- 2004/06/03 05:00
MHDA- 2004/06/30 05:00
CRDT- 2004/06/03 05:00
PHST- 2003/12/02 00:00 [accepted]
PHST- 2004/06/03 05:00 [pubmed]
PHST- 2004/06/30 05:00 [medline]
PHST- 2004/06/03 05:00 [entrez]
AID - S0003497504001158 [pii]
AID - 10.1016/j.athoracsur.2003.12.035 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2004 Jun;77(6):1966-77. doi: 10.1016/j.athoracsur.2003.12.035.