California Cardiac Surgery Intervention Project

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

Outcome:MACCE (Multiple Adverse Cardiovascular and Cerebral Events)
This outcome is determined based on the occurrence of 1 or more of the following events after the index surgery or a subsequent inpatient-readmission connected through the surgery admission via acute transfer:
  • Death during the surgery admission or during a connected inpatient re-admission; disposition code '11' is used to identify in-hospital deaths.
  • Post OP Myocardial Infarction (MI) defined as MI during the surgery admission that was not present at admission or an MI during a connected inpatient re-admission; 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 a connected inpatient re-admission; 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 a connected acute inpatient re-admission. 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 (36.01, 36.02, 36.05, 36.06, 36.09, 00.66) is also considered a re-intervention.
All events are weighted equally.
Model Statistics:
Number of Observations: 12,544
% of Observations with Outcome: 5.5%
C-statistic: 0.709Pseudo-R2: 8.9Hosmer-Lemeshow P-Value: 0.336
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 -3.7 0.1 680.5 0.000
Age at Admission18-<50 1,501 3.8 -0.6 0.2 9.9 0.002 0.6 0.4 0.8
50-<55 710 4.6 -0.2 0.2 0.8 0.371 0.8 0.5 1.3
55-<60 1,167 4.0 -0.2 0.2 1.6 0.204 0.8 0.5 1.1
60-<65 1,403 5.0 -0.0 0.2 0.0 0.985 1.0 0.7 1.4
65-<70 1,773 4.9Reference
70-<75 1,823 4.9 0.0 0.2 0.1 0.804 1.0 0.8 1.4
75-<80 1,814 6.6 0.3 0.2 4.6 0.031 1.4 1.0 1.9
80 or older 2,353 7.8 0.6 0.1 16.4 0.000 1.8 1.3 2.3
Patient SexMale 7,107 4.9Reference
Female 5,437 6.2 0.2 0.1 7.0 0.008 1.2 1.1 1.5
RaceWhite 9,562 5.4Reference
Black 554 6.6 0.1 0.2 0.3 0.595 1.1 0.8 1.6
Other race 1,450 4.9 -0.3 0.1 3.7 0.053 0.8 0.6 1.0
Asian/Pacific Islander 978 6.0 0.1 0.1 0.8 0.362 1.1 0.9 1.5
EthnicityHispanic 2,245 6.5 0.4 0.1 11.0 0.001 1.5 1.2 1.8
Non-Hispanic 10,299 5.3Reference
Type of Valve ProcedureAV-Replacement Only 7,418 4.9Reference
MV-Replacement Only 1,700 7.7 0.3 0.1 8.5 0.003 1.4 1.1 1.8
MV-Repair Only 1,941 3.0 -0.3 0.2 3.9 0.049 0.7 0.6 1.0
Multiple Valves including AVR, MVR or MV-Repair 1,485 8.8 0.4 0.1 7.3 0.007 1.5 1.1 1.9
Acute MI Present at Scheduled Admission 36 19.4 1.4 0.4 10.6 0.001 4.2 1.8 10.1
Acute MI Present at Unscheduled Admission 203 15.4 0.6 0.2 7.2 0.007 1.8 1.2 2.8
Aortic/Mitral Valve Disease/Stenosis/Insufficiency 1,639 7.3 0.1 0.1 1.6 0.201 1.2 0.9 1.4
Atrial Fibrillation and Flutter 3,952 6.6 0.1 0.1 0.9 0.342 1.1 0.9 1.3
Cardiogenic Shock 143 18.2 0.8 0.2 12.2 0.000 2.3 1.4 3.7
Cardiomyopathy 1,346 6.5 0.1 0.1 0.3 0.585 1.1 0.8 1.4
Heart Failure 5,333 7.3 0.3 0.1 13.4 0.000 1.4 1.2 1.6
HX Sudden Cardiac Arrest (Begin 2007) 43 2.3 -0.7 1.0 0.4 0.503 0.5 0.1 3.7
Chronic Lung Disease 1,252 6.7 0.1 0.1 1.3 0.248 1.2 0.9 1.5
Cerebrovascular Disease 810 8.6 0.2 0.1 2.4 0.123 1.2 0.9 1.6
Diabetes 3,256 5.8 -0.2 0.1 3.2 0.074 0.8 0.7 1.0
Dialysis 196 18.9 0.7 0.2 10.8 0.001 2.0 1.3 3.1
Infectious Endocarditis 766 13.1 1.1 0.1 62.6 0.000 2.9 2.3 3.8
Pre-Op Intra-Aortic Balloon Pump 186 18.3 1.1 0.2 29.4 0.000 3.1 2.1 4.7
Prior CABG/Valve Surgery 920 8.2 0.4 0.1 7.9 0.005 1.5 1.1 1.9
Peripheral Vascular Disease 1,573 5.4 -0.2 0.1 2.9 0.090 0.8 0.6 1.0
Renal Failure 2,296 9.1 0.4 0.1 17.5 0.000 1.5 1.2 1.8
Same Day Tricuspid Valve 561 10.4 0.3 0.2 2.0 0.154 1.3 0.9 1.9
Status of Procedure Urgent 69 14.5 0.9 0.4 6.0 0.014 2.5 1.2 5.1
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

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