Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

Niki Lijftogt; Anco Vahl; Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing; Esmee M van der Willik; Vanessa J Leijdekkers; Michel W J M Wouters; Jaap F Hamming

doi:10.1016/j.avsg.2019.02.032

Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

Niki Lijftogt^*
, Anco Vahl
, Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing
, Esmee M van der Willik
, Vanessa J Leijdekkers
, Michel W J M Wouters
, Jaap F Hamming

^*Corresponding author for this work

Onze Lieve Vrouwe Gasthuis
Leiden University
Dutch Institute for Clinical Auditing (DICA)
Leiden University Medical Centre

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

Abstract

BACKGROUND: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.

METHODS: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05.

RESULTS: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.

CONCLUSIONS: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

Original language	English
Pages (from-to)	103-111
Number of pages	9
Journal	Annals of Vascular Surgery
Volume	60
DOIs	https://doi.org/10.1016/j.avsg.2019.02.032
Publication status	Published - Oct 2019
Externally published	Yes

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Lijftogt, N., Vahl, A., Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing, van der Willik, E. M., Leijdekkers, V. J., Wouters, M. W. J. M., & Hamming, J. F. (2019). Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit. Annals of Vascular Surgery, 60, 103-111. https://doi.org/10.1016/j.avsg.2019.02.032

@article{4ffc5e42fd0a45848e7d56c39f822971,

title = "Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit",

abstract = "BACKGROUND: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.METHODS: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05.RESULTS: There were 12,401 patients: 9,537 (76.9\%) elective patients (EAAA), 913 (7.4\%) acute symptomatic patients (SAAA), and 1,951 (15.7\%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5\%; 1.8\% after EAAA surgery, 6.6\% after SAAA, and 29.6\% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.CONCLUSIONS: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.",

author = "Niki Lijftogt and Anco Vahl and \{Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing\} and \{van der Willik\}, \{Esmee M\} and Leijdekkers, \{Vanessa J\} and Wouters, \{Michel W J M\} and Hamming, \{Jaap F\}",

year = "2019",

month = oct,

doi = "10.1016/j.avsg.2019.02.032",

language = "English",

volume = "60",

pages = "103--111",

journal = "Annals of Vascular Surgery",

issn = "0890-5096",

publisher = "Elsevier Inc.",

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Lijftogt, N, Vahl, A, Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing, van der Willik, EM, Leijdekkers, VJ, Wouters, MWJM & Hamming, JF 2019, 'Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit', Annals of Vascular Surgery, vol. 60, pp. 103-111. https://doi.org/10.1016/j.avsg.2019.02.032

Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit. / Lijftogt, Niki; Vahl, Anco; Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing et al.
In: Annals of Vascular Surgery, Vol. 60, 10.2019, p. 103-111.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

AU - Lijftogt, Niki

AU - Vahl, Anco

AU - Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing

AU - van der Willik, Esmee M

AU - Leijdekkers, Vanessa J

AU - Wouters, Michel W J M

AU - Hamming, Jaap F

PY - 2019/10

Y1 - 2019/10

N2 - BACKGROUND: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.METHODS: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05.RESULTS: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.CONCLUSIONS: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

AB - BACKGROUND: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.METHODS: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05.RESULTS: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.CONCLUSIONS: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

U2 - 10.1016/j.avsg.2019.02.032

DO - 10.1016/j.avsg.2019.02.032

M3 - Article

C2 - 31075453

SN - 0890-5096

VL - 60

SP - 103

EP - 111

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

ER -

Lijftogt N, Vahl A, Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing, van der Willik EM, Leijdekkers VJ, Wouters MWJM et al. Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit. Annals of Vascular Surgery. 2019 Oct;60:103-111. doi: 10.1016/j.avsg.2019.02.032

Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

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