• CMAJ · Nov 2021

    Derivation and validation of predictive indices for 30-day mortality after coronary and valvular surgery in Ontario, Canada.

    • Louise Y Sun, Anna Chu, Derrick Y Tam, Xuesong Wang, Jiming Fang, Peter C Austin, Christopher M Feindel, Garth H Oakes, Vicki Alexopoulos, Natasa Tusevljak, Maral Ouzounian, Douglas S Lee, and CorHealth Ontario Cardiac Surgery Risk Adjustment Task Group.
    • Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute, Ottawa, Ont.; ICES Central (Sun, Chu, Tam, Wang, Fang, Austin, Tusevljak, Lee), Toronto, Ont.; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; Sunnybrook Health Sciences Centre (Tam); University Health Network and Peter Munk Cardiac Centre (Feindel, Ouzounian, Lee); Departments of Cardiac Surgery (Tam, Feindel, Ouzounian), Physical Therapy (Chu), Surgery (Feindel), Cardiology (Lee), University of Toronto, Toronto, Ont.; Institute for Health Policy, Management and Evaluation (Austin), University of Toronto, Toronto, Ont.; CorHealth Ontario (Oakes, Alexopoulos), Toronto, Ont.
    • CMAJ. 2021 Nov 22; 193 (46): E1757-E1765.

    BackgroundCoronary artery bypass grafting (CABG) and surgical aortic valve replacement (AVR) are the 2 most common cardiac surgery procedures in North America. We derived and externally validated clinical models to estimate the likelihood of death within 30 days of CABG, AVR or combined CABG + AVR.MethodsWe obtained data from the CorHealth Ontario Cardiac Registry and several linked population health administrative databases from Ontario, Canada. We derived multiple logistic regression models from all adult patients who underwent CABG, AVR or combined CABG + AVR from April 2017 to March 2019, and validated them in 2 temporally distinct cohorts (April 2015 to March 2017 and April 2019 to March 2020).ResultsThe derivation cohorts included 13 435 patients who underwent CABG (30-d mortality 1.73%), 1970 patients who underwent AVR (30-d mortality 1.68%) and 1510 patients who underwent combined CABG + AVR (30-d mortality 3.05%). The final models for predicting 30-day mortality included 15 variables for patients undergoing CABG, 5 variables for patients undergoing AVR and 5 variables for patients undergoing combined CABG + AVR. Model discrimination was excellent for the CABG (c-statistic 0.888, optimism-corrected 0.866) AVR (c-statistic 0.850, optimism-corrected 0.762) and CABG + AVR (c-statistic 0.844, optimism-corrected 0.776) models, with similar results in the validation cohorts.InterpretationOur models, leveraging readily available, multidimensional data sources, computed accurate risk-adjusted 30-day mortality rates for CABG, AVR and combined CABG + AVR, with discrimination comparable to more complex American and European models. The ability to accurately predict perioperative mortality rates for these procedures will be valuable for quality improvement initiatives across institutions.© 2021 CMA Joule Inc. or its licensors.

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