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Ann Thorac Surg 1999;67:635-640
© 1999 The Society of Thoracic Surgeons

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Original Article

Subjective versus statistical model assessment of mortality risk in open heart surgical procedures

^a Catalan Agency for Health Technology Assessment, Catalan Health Service, Department of Health, Generalitat de Catalunya, Barcelona, Spain
^b Catalan Institute of Oncology, Catalan Health Service, Department of Health, Generalitat de Catalunya, Barcelona, Spain

Accepted for publication July 29, 1998.

Address reprint requests to Dr Pons, Catalan Agency for Health Technology Assessment, Travessera de les Corts 131–159, Pavelló Ave Maria, 08028 Barcelona, Spain

Presented at the Fourteenth Annual Meeting of the International Society of Technology Assessment in Health Care, Ottawa, Ont, Canada, June 7–10, 1998.

Background. The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons’ subjective risk assessment.

Methods. Predictive discrimination of both risk assessments (surgeons’ and model) was compared through the area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the relation between surgeons’ and model predictions to actual outcomes. Calibration of the subjective estimates was evaluated with a ² test.

Results. Overall, the area under the receiver operating characteristic curve was 0.76 for the statistical model and 0.70 for the subjective assessment. Logistic regression analysis showed that the statistical model remained significant after accounting for the subjective assessment. Calibration of subjective mortality predictions was poor.

Conclusions. Surgeons’ risk assessment tends to cluster in the middle ranges of risk. Subjective assessment seems accurate in identifying the two extremes of risk but is inaccurate for intermediate risk levels. A multivariate statistical model improves the accuracy of subjective predictions.

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