PMID- 31055196
OWN - NLM
STAT- MEDLINE
DCOM- 20200430
LR  - 20200430
IS  - 1873-4529 (Electronic)
IS  - 0952-8180 (Linking)
VI  - 58
DP  - 2019 Dec
TI  - Validation of the LACE readmission and mortality prediction model in a large 
      surgical cohort: Comparison of performance at preoperative assessment and 
      discharge time points.
PG  - 22-26
LID - S0952-8180(19)30176-X [pii]
LID - 10.1016/j.jclinane.2019.04.039 [doi]
AB  - STUDY OBJECTIVE: The LACE index (Length of stay, admission Acuity, Charlson 
      comorbidity index, and Emergency department visits within 6 months of current 
      admission) is a practical tool designed to predict the risk of readmission or 
      mortality within 30 days of hospital discharge. We sought to validate and examine 
      its performance in a large surgical population at both the preoperative 
      assessment and discharge time points. DESIGN: Retrospective cohort study. 
      SETTING: We identified all admissions with a surgery or procedure at Vanderbilt 
      University Medical Center (VUMC) between 2010 and 2015. PATIENTS: A total of 
      192,670 admissions (age >/= 18) were included in the study. INTERVENTIONS: None. 
      MEASUREMENTS: LACE scores were calculated and analyzed with multivariable 
      logistic regression. Discrimination was assessed with the c-statistic, 
      calibration was assessed with calibration plots, and overall performance 
      evaluated with the Brier score. Four models were created: admissions with any 
      surgery or procedure, surgical admissions using actual length of stay (ALOS), 
      surgical admissions using estimated length of stay (ELOS) and non-surgical 
      procedural admissions. MAIN RESULTS: 192,670 admissions were included. The all 
      admissions model c-statistic was 0.77 with a Brier score of 0.13. Surgical 
      admissions with ALOS and ELOS had a c-statistic of 0.80, 0.82 and a Brier score 
      of 0.10, 0.08 respectively. Non-surgical procedural admissions had a c-statistic 
      of 0.76 and a Brier score of 0.14. Calibration for all models was adequate. 
      CONCLUSIONS: The LACE model for surgical and procedural admissions had good 
      discrimination and adequate calibration. Analysis of the model applied to 
      surgical admissions using ELOS demonstrated slightly better overall performance 
      than ALOS, suggesting that LACE could be utilized for readmission risk 
      stratification at the time of preoperative assessment. Clinical Trial and 
      Registry URL: Not applicable.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Shaffer, Brett K
AU  - Shaffer BK
AD  - Vanderbilt University Medical Center, 2301 Vanderbilt University Hospital, 
      Nashville, TN 37232, USA.
FAU - Cui, Yu
AU  - Cui Y
AD  - Chengdu Women and Children Central Hospital, No.1617, Riyue Avenue, Qingyang 
      district, Chengdu 610091, China.
FAU - Wanderer, Jonathan P
AU  - Wanderer JP
AD  - Vanderbilt University Medical Center, 2301 Vanderbilt University Hospital, 
      Nashville, TN 37232, USA. Electronic address: jon.wanderer@vumc.org.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Validation Study
DEP - 20190502
PL  - United States
TA  - J Clin Anesth
JT  - Journal of clinical anesthesia
JID - 8812166
SB  - IM
MH  - Cohort Studies
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - *Models, Statistical
MH  - Patient Discharge
MH  - Patient Readmission/*statistics & numerical data
MH  - Retrospective Studies
MH  - Surgical Procedures, Operative/*statistics & numerical data
MH  - Time Factors
OTO - NOTNLM
OT  - LACE scores
OT  - Mortality
OT  - Readmissions
OT  - Surgical admissions
EDAT- 2019/05/06 06:00
MHDA- 2020/05/01 06:00
CRDT- 2019/05/06 06:00
PHST- 2019/02/01 00:00 [received]
PHST- 2019/04/24 00:00 [revised]
PHST- 2019/04/26 00:00 [accepted]
PHST- 2019/05/06 06:00 [pubmed]
PHST- 2020/05/01 06:00 [medline]
PHST- 2019/05/06 06:00 [entrez]
AID - S0952-8180(19)30176-X [pii]
AID - 10.1016/j.jclinane.2019.04.039 [doi]
PST - ppublish
SO  - J Clin Anesth. 2019 Dec;58:22-26. doi: 10.1016/j.jclinane.2019.04.039. Epub 2019 
      May 2.