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) |
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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
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Model Statistics: |
| Number of Observations: 4,949 |
| % of Observations with Outcome: 12.7% |
| C-statistic: 0.665 | Pseudo-R2: 6.6 | Hosmer-Lemeshow P-Value: 0.015 |
Model Details: |
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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 Admission | 18-<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 | 12.1 | | | | Reference | | | |
| 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 Sex | Male | 3,435 | 11.1 | | | | Reference | | | |
| Female | 1,514 | 16.2 | 0.5 | 0.1 | 24.5 | 0.000 | 1.6 | 1.3 | 1.9 |
Race | White | 3,903 | 12.2 | | | | Reference | | | |
| 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 |
Ethnicity | Hispanic | 786 | 12.5 | 0.0 | 0.1 | 0.0 | 0.861 | 1.0 | 0.8 | 1.3 |
| Non-Hispanic | 4,163 | 12.7 | | | | Reference | | | |
Type of Valve Procedure | AV-Replacement Only | 3,119 | 10.9 | | | | Reference | | | |
| 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 Grafts | One | 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 | 14.1 | | | | Reference | | | |
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 |
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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 |