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Ann Thorac Surg 2004;77:2232-2237
© 2004 The Society of Thoracic Surgeons

Review

Cardiac surgery risk modeling for mortality: a review of current practice and suggestions for improvement

Rumana Z. Omar, PhDa,b, Gareth Ambler, PhDa,b, Patrick Royston, DScc, Joseph Eliahoo, MSb, Kenneth M. Taylor, FRCSd*

a Department of Statistical Science, University College London, London, United Kingdom
b Medical Statistics Unit, Research and Development Directorate, University College London Hospitals NHS Trust, London, United Kingdom
c MRC Clinical Trials Unit London, London, United Kingdom
d Department of Cardiac Surgery, British Heart Foundation, Hammersmith Hospital, Imperial College London Faculty of Medicine, London, United Kingdom

* Address reprint requests to Dr Taylor, Department of Cardiac Surgery, Faculty of Medicine, Imperial College, Hammersmith Hospital, Du Cane Rd, London W12 ONN, UK.
e-mail: k.m.taylor{at}imperial.ac.uk

Risk models play a vital role in monitoring health care performances. Despite extensive research and widespread use of risk models in cardiac surgery, there are methodologic problems. We reviewed the methodology used for risk models for short-term mortality. The findings suggest that many risk models are developed in an ad hoc manner. Important aspects such as selection of risk factors, handling of missing values, and size of the data used for model development are not dealt with adequately. Methodologic details presented in publications are often sparse and unclear. Model development and validation processes are not always linked to the clinical aim of the model, which may affect their clinical validity. We make some suggestions in this review for improvement in methodology and reporting.




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