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Article
Predicting the occurrence of adverse events after coronary artery bypass surgery
Quantitative Health Sciences Publications and Presentations
  • Jane M. Geraci, Boston University
  • Amy K. Rosen, Boston University
  • Arlene S. Ash, University of Massachusetts Medical School
  • Kathleen J. McNiff, Boston University
  • Mark A. Moskowitz, Boston University
UMMS Affiliation
Department of Quantitative Health Sciences
Date
1-1-1993
Document Type
Article
Medical Subject Headings
Aged; Coronary Artery Bypass; Female; Humans; Logistic Models; Male; Medicare; Prevalence; Quality of Health Care; ROC Curve; Retrospective Studies; Risk Factors; Severity of Illness Index; United States
Abstract
OBJECTIVE: To determine whether adverse events occurring after coronary artery bypass surgery in Medicare patients can be predicted from clinical variables representing illness severity at admission. DESIGN: Retrospective analysis of clinical data abstracted from hospital charts, with development and validation using half-samples of the database. A logistic model was developed using illness severity at admission to predict the occurrence of an adverse event after bypass surgery. SETTING: Hospitals in seven states. PATIENTS: Random sample of 2213 Medicare patients 65 years of age or more who underwent bypass surgery between January 1985 and June 1986. OUTCOME MEASURE: The occurrence of death within 30 days of admission or any of 13 nonfatal postoperative adverse events (for example, myocardial infarction, congestive heart failure, and wound infection). RESULTS: Thirty-three percent of patients had one or more postoperative adverse events or died within 30 days of admission. Mortality within 30 days of admission was 6.6%; each adverse event was associated with increased mortality (range, 7.5% to 66.7%). Admission predictors of the occurrence of an adverse event included a history of bypass surgery, emergent surgery, a history of chronic obstructive pulmonary disease, the presence of an infiltrate on admission chest radiograph, a pulse of 110 beats/min or more, age, blood urea nitrogen of 10.7 mmol/L (30 mg/dL) or more, acute myocardial infarction at admission, and a history of myocardial infarction; the presence of one- or two-vessel disease was negatively associated with the occurrence of an adverse event. The model c-statistic was 0.64. CONCLUSIONS: Severity of illness at admission has modest predictive power with respect to adverse-event occurrence in Medicare patients who undergo bypass surgery.
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Citation: Ann Intern Med. 1993 Jan 1;118(1):18-24. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Citation Information
Jane M. Geraci, Amy K. Rosen, Arlene S. Ash, Kathleen J. McNiff, et al.. "Predicting the occurrence of adverse events after coronary artery bypass surgery" Vol. 118 Iss. 1 (1993) ISSN: 0003-4819 (Linking)
Available at: http://works.bepress.com/arlene_ash/28/