California Cardiac Surgery Intervention Project

Summary of CABG/Valve Model based on California Inpatient Discharge Data, 2012-2013

Outcome:MACCE-90 (Multiple Adverse Cardiovascular and Cerebral Events within 90 Days of surgery)
This outcome is determined based on the occurrence of 1 or more of the following events within 90 days of the surgery date:
  • Death during the surgery admission or during an emergency department encounter or inpatient re-admission within 90 days of the surgery; disposition code '11' is used to identify in-hospital deaths; disposition code '20' is used to identify ED deaths.
  • Post OP Myocardial Infarction (MI) defined as MI during the surgery admission that was not present at admission or an MI during an inpatient re-admission within 90 days of surgery; ICD-9-CM codes used to identify MIs: 410.xx.
  • Post OP Stroke defined as stroke during the surgery admission that was not present at admission or stroke during an inpatient re-admission within 90 days of surgery; ICD-9-CM codes used to identify Strokes: 997.02, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91.
  • Re-Intervention defined as any cardiac surgery / intervention during the index surgery admission that occurred at least 1 day after the index surgery or a cardiac surgery / intervention during an inpatient re-admission within 90 days of surgery Any procedure in the range 35.xx-38.xx that was performed using ECC (ICD-9-CM procedure code 39.61) is considered a re-intervention. Furthermore, any off-pump CABG procedure (36.1) or any PCI (ICD-9-CM for inpatient data: 36.01, 36.02, 36.05, 36.06, 36.09, 00.66; CPT codes for Ambulatory Surgery / Emergency Department data for 2012 or earlier: 92980, 92981, 92982, 92983, 92984, 92995, 92996; CPT codes for Ambulatory Surgery / Emergency Department data for 2013: 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944) is also considered a re-intervention.
All events are weighted equally.
Only patients are included who did not leave against medical advice, who were residents of California at the time of the surgery, and who had surgery after 2013-10-02
Model Statistics:
Number of Observations: 4,949
% of Observations with Outcome: 12.7%
C-statistic: 0.665Pseudo-R2: 6.6Hosmer-Lemeshow P-Value: 0.015
Model Details:
Risk Factor N Cases % Events Estimate Standard Error Wald Chi2 P-value Odds Ratio (OR) Lower 95% CL for OR Upper 95% CL for OR
Intercept -2.6 0.2 242.0 0.000
Age at Admission18-<50 129 16.1 0.1 0.3 0.1 0.771 1.1 0.6 1.9
50-<55 151 9.4 -0.4 0.3 1.2 0.273 0.7 0.4 1.3
55-<60 276 14.8 0.2 0.2 0.8 0.359 1.2 0.8 1.9
60-<65 451 11.2 -0.1 0.2 0.4 0.548 0.9 0.6 1.3
65-<70 727 12.1Reference
70-<75 887 10.6 -0.1 0.2 0.8 0.369 0.9 0.6 1.2
75-<80 1,004 12.7 0.1 0.2 0.5 0.498 1.1 0.8 1.5
80 or older 1,324 14.4 0.3 0.1 3.7 0.053 1.3 1.0 1.8
Patient SexMale 3,435 11.1Reference
Female 1,514 16.2 0.5 0.1 24.5 0.000 1.6 1.3 1.9
RaceWhite 3,903 12.2Reference
Black 167 17.7 0.2 0.2 0.8 0.373 1.2 0.8 1.9
Other race 515 12.0 -0.1 0.2 0.4 0.543 0.9 0.7 1.2
Asian/Pacific Islander 364 16.1 0.2 0.2 1.7 0.198 1.2 0.9 1.7
EthnicityHispanic 786 12.5 0.0 0.1 0.0 0.861 1.0 0.8 1.3
Non-Hispanic 4,163 12.7Reference
Type of Valve ProcedureAV-Replacement Only 3,119 10.9Reference
MV-Replacement Only 458 15.9 0.2 0.2 2.6 0.104 1.3 1.0 1.7
MV-Repair Only 838 13.6 0.1 0.1 0.2 0.662 1.1 0.8 1.4
Multiple Valves including AVR, MVR or MV-Repair 534 18.7 0.4 0.2 5.3 0.021 1.5 1.1 2.0
Acute MI Present at Scheduled Admission 118 10.5 -0.3 0.3 0.7 0.405 0.8 0.4 1.4
Acute MI Present at Unscheduled Admission 695 17.6 0.2 0.1 2.0 0.158 1.2 0.9 1.5
Aortic/Mitral Valve Disease/Stenosis/Insufficiency 660 17.0 0.2 0.1 2.0 0.155 1.2 0.9 1.6
Atrial Fibrillation and Flutter 1,338 13.6 0.0 0.1 0.0 0.949 1.0 0.8 1.2
Cardiogenic Shock 146 28.8 0.8 0.2 14.4 0.000 2.2 1.5 3.4
Cardiomyopathy 449 15.0 0.1 0.1 0.4 0.542 1.1 0.8 1.5
Heart Failure 2,366 15.5 0.3 0.1 8.4 0.004 1.3 1.1 1.6
HX Sudden Cardiac Arrest (Begin 2007) 19 10.5 -0.3 0.8 0.2 0.672 0.7 0.2 3.3
Chronic Lung Disease 758 15.8 0.3 0.1 6.7 0.010 1.3 1.1 1.7
Cerebrovascular Disease 453 13.0 -0.1 0.2 0.2 0.657 0.9 0.7 1.3
Diabetes 1,977 12.9 -0.1 0.1 0.3 0.586 0.9 0.8 1.1
Dialysis 131 23.0 0.4 0.2 2.6 0.106 1.5 0.9 2.3
Infectious Endocarditis 86 22.6 0.6 0.3 4.1 0.042 1.8 1.0 3.1
Number of GraftsOne 1,739 11.3 -0.3 0.1 6.7 0.010 0.7 0.6 0.9
Two 1,366 12.5 -0.2 0.1 1.9 0.174 0.9 0.7 1.1
Three or More 1,844 14.1Reference
PCI prior to Admission 619 10.0 -0.3 0.1 3.3 0.068 0.8 0.6 1.0
Prior PCI on same Day as Surgery 8 25.0 0.3 0.9 0.1 0.768 1.3 0.2 7.1
Pre-Op Intra-Aortic Balloon Pump 119 23.9 0.6 0.3 4.9 0.027 1.7 1.1 2.8
Prior CABG/Valve Surgery 202 18.2 0.5 0.2 6.9 0.008 1.7 1.1 2.5
Peripheral Vascular Disease 938 14.3 0.1 0.1 1.3 0.251 1.1 0.9 1.4
Renal Failure 1,340 16.5 0.3 0.1 9.2 0.002 1.4 1.1 1.7
Same Day Tricuspid Valve 117 16.7 -0.0 0.3 0.0 0.919 1.0 0.5 1.7
Status of Procedure Urgent 70 21.7 0.2 0.3 0.5 0.483 1.3 0.7 2.4
Notes:
If a patient had more than one surgery event of the same type on different dates during the index admission, only the surgery on the earliest date is included for fitting the model.
CL: Confidence Limit
CABG: Coronary Artery Bypass Graft
PCI: Percutaneous Coronary Intervention

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