California Cardiac Surgery Intervention Project

Summary of Isolated Valve (SAVR, MVR, MV Repair or Multiple Valve) Model based on California Inpatient Discharge Data, 2014-2015

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; IP disposition code (prior 2015) '11' or (2015 or later) '20' 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. ICD-10-CM codes used to identify MIs: I21.1x, I21.2x, I21.3, I22.0, I22.1, I22.8, I22.9, I21.4, I22.2.
  • 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. ICD-10-CM codes used to identify Strokes: I63.xx, G97.31, G97.32, I97.81x, I97.82x.
  • 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 ICD-9-PCS range 35.xx-38.xx or ICD-10-PCS 02xxxxx that was performed using ECC (ICD-9-PCS: 39.61, ICD-10-PCS: 5A12xxx, 5A15xxx) or off-pump CABG procedure (ICD-9-PCS: 36.1x, ICD-10-PCS: 0210xxx, 0211xxx, 0212xxx, 0213xxx) is considered a re-intervention. Furthermore, any PCI (ICD-9-PCS for IP data: 36.01, 36.02, 36.05, 36.06, 36.09, 00.66; ICD-10-PCS for IP data: 02703xx, 02713xx, 02723xx, 02733xx, 02C03xx, 02C13xx, 02C23xx, 02C33xx; 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 2015-10-02
Model Statistics:
Number of Observations: 11,154
% of Observations with Outcome: 7.3%
C-statistic: 0.683Pseudo-R2: 7.5Hosmer-Lemeshow P-Value: 0.960
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
-3.4
0.1
660.2
0.000
Age at Admission18-<50
1,419
6.3
-0.2
0.2
2.4
0.124
0.8
0.6
1.1
50-<55
654
7.0
-0.1
0.2
0.3
0.606
0.9
0.6
1.3
55-<60
1,107
6.2
-0.2
0.2
1.1
0.293
0.8
0.6
1.2
60-<65
1,422
6.0
-0.2
0.2
1.9
0.163
0.8
0.6
1.1
65-<70
1,655
6.9
Reference
70-<75
1,722
8.2
0.2
0.1
2.9
0.089
1.3
1.0
1.6
75-<80
1,524
8.0
0.2
0.1
1.2
0.282
1.2
0.9
1.5
80 or older
1,651
9.1
0.4
0.1
7.5
0.006
1.5
1.1
1.9
Patient SexMale
6,470
6.8
Reference
Female
4,684
8.0
0.1
0.1
3.4
0.063
1.2
1.0
1.4
Patient RaceWhite
7,212
6.6
Reference
Non-White
3,942
8.7
0.2
0.1
7.0
0.008
1.2
1.1
1.5
Type of Valve ProcedureSAVR Only
5,877
6.1
Reference
MVR Only
1,611
9.9
0.4
0.1
11.3
0.001
1.5
1.2
1.8
MV Repair Only
1,854
5.2
0.0
0.1
0.0
0.928
1.0
0.8
1.3
Multiple Valves including SAVR, MVR or MV Repair
1,812
11.1
0.5
0.1
13.7
0.000
1.6
1.2
2.0
Acute MI Present at Scheduled Admission
42
13.3
0.5
0.5
0.9
0.335
1.6
0.6
4.5
Acute MI Present at Unscheduled Admission
196
19.5
0.8
0.2
15.9
0.000
2.2
1.5
3.3
Aortic/Mitral Valve Disease/Stenosis/Insufficiency
1,604
9.0
0.0
0.1
0.0
0.965
1.0
0.8
1.2
Atrial Fibrillation and Flutter
3,711
8.5
0.1
0.1
0.4
0.513
1.1
0.9
1.2
Cardiogenic Shock
172
17.0
0.5
0.2
4.2
0.039
1.6
1.0
2.5
Cardiomyopathy
1,385
9.6
0.2
0.1
3.1
0.080
1.2
1.0
1.5
Heart Failure
4,861
9.5
0.3
0.1
11.4
0.001
1.3
1.1
1.6
HX Sudden Cardiac Arrest (Begin 2007)
42
7.8
-0.1
0.6
0.0
0.913
0.9
0.3
3.2
Chronic Lung Disease
1,071
9.0
0.1
0.1
1.0
0.309
1.1
0.9
1.4
Cerebrovascular Disease
671
10.2
0.1
0.1
1.0
0.320
1.2
0.9
1.5
Diabetes
2,791
8.9
0.1
0.1
2.2
0.136
1.1
1.0
1.4
Dialysis
205
26.4
0.9
0.2
23.8
0.000
2.5
1.7
3.6
Infectious Endocarditis
676
15.3
0.8
0.1
31.0
0.000
2.1
1.6
2.8
Pre-Op Intra-Aortic Balloon Pump
119
21.9
1.1
0.2
18.8
0.000
2.9
1.8
4.8
Prior CABG/Valve Surgery
777
11.6
0.4
0.1
11.8
0.001
1.5
1.2
2.0
Peripheral Vascular Disease
1,308
7.4
-0.1
0.1
1.4
0.229
0.9
0.7
1.1
Renal Failure
2,165
11.7
0.3
0.1
14.1
0.000
1.4
1.2
1.7
Same Day Tricuspid Valve
516
12.4
0.1
0.2
0.3
0.592
1.1
0.8
1.5
Status of Procedure Urgent
62
15.1
0.5
0.4
1.7
0.199
1.7
0.8
3.6
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
SAVR: Surgical Aortic Valve Replacement
MVR: Mitral Valve Replacement
MV Repair: Mitral Valve Repair
N Cases % Events Estimate Standard Error Wald Chi2 P-Value Odds Ratio (OR) Lower 95% CL for OR Upper 95% CL for OR
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