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 (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; IP disposition code (prior 2015) '11' or (2015 or later) '20' 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: 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 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. 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 a connected acute inpatient re-admission. 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) is also considered a re-intervention.
All events are weighted equally.
Model Statistics:
Number of Observations: 12,502
% of Observations with Outcome: 5.1%
C-statistic: 0.705Pseudo-R2: 8.0Hosmer-Lemeshow P-Value: 0.417
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
674.1
0.000
Age at Admission18-<50
1,594
4.0
-0.5
0.2
7.7
0.006
0.6
0.4
0.9
50-<55
719
4.6
-0.3
0.2
1.4
0.245
0.8
0.5
1.2
55-<60
1,234
4.4
-0.2
0.2
1.9
0.171
0.8
0.5
1.1
60-<65
1,596
3.7
-0.4
0.2
4.7
0.030
0.7
0.5
1.0
65-<70
1,850
4.9
Reference
70-<75
1,931
6.2
0.3
0.1
4.4
0.035
1.4
1.0
1.8
75-<80
1,741
5.6
0.2
0.2
1.1
0.298
1.2
0.9
1.6
80 or older
1,837
6.5
0.4
0.1
6.8
0.009
1.5
1.1
2.0
Patient SexMale
7,257
4.7
Reference
Female
5,245
5.6
0.1
0.1
2.8
0.097
1.2
1.0
1.4
Patient RaceWhite
8,099
4.6
Reference
Non-White
4,403
6.1
0.2
0.1
5.8
0.016
1.2
1.0
1.5
Type of Valve ProcedureSAVR Only
6,699
4.1
Reference
MVR Only
1,815
7.4
0.5
0.1
16.7
0.000
1.6
1.3
2.1
MV Repair Only
1,993
3.3
0.0
0.1
0.1
0.782
1.0
0.7
1.3
Multiple Valves including SAVR, MVR or MV Repair
1,995
8.2
0.6
0.1
17.1
0.000
1.7
1.3
2.3
Acute MI Present at Scheduled Admission
44
11.7
0.7
0.5
1.7
0.192
1.9
0.7
5.3
Acute MI Present at Unscheduled Admission
226
14.2
0.7
0.2
11.3
0.001
2.0
1.3
3.1
Aortic/Mitral Valve Disease/Stenosis/Insufficiency
1,837
6.9
0.1
0.1
0.4
0.536
1.1
0.9
1.4
Atrial Fibrillation and Flutter
4,118
5.8
0.0
0.1
0.1
0.733
1.0
0.8
1.2
Cardiogenic Shock
204
18.1
0.9
0.2
19.7
0.000
2.5
1.7
3.8
Cardiomyopathy
1,528
7.5
0.3
0.1
8.0
0.005
1.4
1.1
1.7
Heart Failure
5,426
6.7
0.2
0.1
5.1
0.024
1.2
1.0
1.5
HX Sudden Cardiac Arrest (Begin 2007)
51
6.1
0.0
0.6
0.0
0.980
1.0
0.3
3.4
Chronic Lung Disease
1,212
5.7
0.0
0.1
0.0
0.958
1.0
0.8
1.3
Cerebrovascular Disease
768
8.0
0.3
0.1
3.0
0.085
1.3
1.0
1.7
Diabetes
3,143
6.0
0.1
0.1
0.3
0.583
1.1
0.9
1.3
Dialysis
224
19.7
0.9
0.2
20.0
0.000
2.4
1.6
3.6
Infectious Endocarditis
765
12.0
0.8
0.1
33.9
0.000
2.3
1.7
3.0
Pre-Op Intra-Aortic Balloon Pump
138
15.3
0.9
0.3
11.4
0.001
2.4
1.5
4.1
Prior CABG/Valve Surgery
884
7.8
0.4
0.1
7.1
0.008
1.4
1.1
1.9
Peripheral Vascular Disease
1,479
5.3
-0.1
0.1
0.7
0.415
0.9
0.7
1.2
Renal Failure
2,422
8.6
0.4
0.1
14.5
0.000
1.5
1.2
1.8
Same Day Tricuspid Valve
591
8.6
0.0
0.2
0.0
0.902
1.0
0.7
1.5
Status of Procedure Urgent
74
9.5
0.3
0.4
0.5
0.476
1.4
0.6
3.2
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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