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: 0.705 | Pseudo-R2: 8.0 | Hosmer-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 Admission | 18-<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 Sex | Male | 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 Race | White | 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 Procedure | SAVR 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 |