|
|
||||||||

a Massachusetts General Hospital, Boston, Massachusetts
b Duke Clinical Research Institute, Durham, North Carolina
c Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas
d University of Kentucky Chandler Medical Center, Division of Cardiovascular and Thoracic Surgery, Lexington, Kentucky
e University of Florida, Division of Cardiothoracic Surgery, Jacksonville, Florida
f Sentara Cardiovascular Research Institute, Norfolk, Virginia
g Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
h The Society of Thoracic Surgeons, Chicago, Illinois
i Seattle, Washington
* Address correspondence to Dr Shahian, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (Email: dshahian{at}partners.org).
Background: The first version of The Society of Thoracic Surgeons National Adult Cardiac Surgery Database (STS NCD) was developed nearly 2 decades ago. Since its inception, the number of participants has grown dramatically, patient acuity has increased, and overall outcomes have consistently improved. To adjust for these and other changes, all STS risk models have undergone periodic revisions. This report provides a detailed description of the 2008 STS risk model for coronary artery bypass grafting surgery (CABG).
Methods: The study population consisted of 774,881 isolated CABG procedures performed on adult patients aged 20 to 100 years between January 1, 2002, and December 31, 2006, at 819 STS NCD participating centers. This cohort was randomly divided into a 60% training (development) sample and a 40% test (validation) sample. The development sample was used to identify predictor variables and estimate model coefficients. The validation sample was used to assess model calibration and discrimination. Model outcomes included operative mortality, renal failure, stroke, reoperation for any cause, prolonged ventilation, deep sternal wound infection, composite major morbidity or mortality, prolonged length of stay (> 14 days), and short length of stay (< 6 days and alive). Candidate predictor variables were selected based on their availability in versions 2.35, 2.41, and 2.52.1 of the STS NCD and their presence in (or ability to be mapped to) version 2.61. Potential predictor variables were screened for overall prevalence in the study population, missing data frequency, coding concerns, bivariate relationships with outcomes, and their presence in previous STS or other CABG risk models. Supervised backwards selection was then performed with input from an expert panel of cardiac surgeons and biostatisticians. After successfully validating the fit of the models, the development and validation samples were subsequently combined, and the final regression coefficients were estimated using the overall combined (development plus validation) sample.
Results: The c-index for the mortality model was 0.812, and the c-indices for other endpoints ranged from 0.653 for reoperation to 0.793 for renal failure in the validation sample. Plots of observed versus predicted event rates revealed acceptable calibration in the overall population and in numerous subgroups. When patients were grouped into categories of predicted risk, the absolute difference between the observed and expected event rates was less than 1.5% for each endpoint. The final model intercept and coefficients are provided.
Conclusions: New STS risk models have been developed for CABG mortality and eight other endpoints. Detailed descriptions of model development and testing are provided, together with the final algorithm. Overall model performance is excellent.
Related Article
Ann. Thorac. Surg. 2009 88: S1.
This article has been cited by other articles:
![]() |
A. W. ElBardissi, S. F. Aranki, S. Sheng, S. M. O'Brien, C. C. Greenberg, and J. S. Gammie Trends in isolated coronary artery bypass grafting: An analysis of the Society of Thoracic Surgeons adult cardiac surgery database. J. Thorac. Cardiovasc. Surg., February 1, 2012; 143(2): 273 - 281. [Abstract] [Full Text] [PDF] |
||||
![]() |
F. O'Boyle, N. Mediratta, B. Fabri, M. Pullan, J. Chalmers, J. McShane, M. Shaw, and M. Poullis Long-term survival after coronary artery bypass surgery stratified by EuroSCORE Eur J Cardiothorac Surg, January 4, 2012; (2012) ezr253v1. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. C. Huen and C. R. Parikh Predicting Acute Kidney Injury After Cardiac Surgery: A Systematic Review Ann. Thorac. Surg., January 1, 2012; 93(1): 337 - 347. [Abstract] [Full Text] [PDF] |
||||
![]() |
I. Qadir, M. M. Salick, S. Perveen, and H. Sharif Mortality from isolated coronary bypass surgery: a comparison of the Society of Thoracic Surgeons and the EuroSCORE risk prediction algorithms Interact CardioVasc Thorac Surg, December 18, 2011; (2011) ivr072v1. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, S. M. Hollenberg, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions J. Am. Coll. Cardiol., December 6, 2011; 58(24): e44 - e122. [Full Text] [PDF] |
||||
![]() |
G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, S. M. Hollenberg, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions J. Am. Coll. Cardiol., December 6, 2011; 58(24): 2550 - 2583. [Full Text] [PDF] |
||||
![]() |
L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 6, 2011; 58(24): e123 - e210. [Full Text] [PDF] |
||||
![]() |
Writing Committee Members, G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation, December 6, 2011; 124(23): e574 - e651. [Full Text] [PDF] |
||||
![]() |
Writing Committee Members, G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation, December 6, 2011; 124(23): 2574 - 2609. [Full Text] [PDF] |
||||
![]() |
Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 6, 2011; 124(23): e652 - e735. [Full Text] [PDF] |
||||
![]() |
V. Farooq, S. Brugaletta, and P. W. Serruys Contemporary and evolving risk scoring algorithms for percutaneous coronary intervention Heart, December 1, 2011; 97(23): 1902 - 1913. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Saxena, D. Dinh, J. A. Smith, G. Shardey, C. M. Reid, and A. E. Newcomb Sex differences in outcomes following isolated coronary artery bypass graft surgery in Australian patients: analysis of the Australasian Society of Cardiac and Thoracic Surgeons cardiac surgery database Eur J Cardiothorac Surg, November 11, 2011; (2011) ezr039v1. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. S. Likosky, S. D. Surgenor, R. S. Kramer, L. Russo, B. J. Leavitt, M. J. Sorensen, R. E. Helm, G. L. Sardella, F. V. DiPierro, Y. R. Baribeau, et al. Effect of Prior Cardiac Operations on Survival After Coronary Artery Bypass Grafting Ann. Thorac. Surg., October 1, 2011; 92(4): 1260 - 1267. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. S. Weiss, J. G. Allen, G. J. Arnaoutakis, T. J. George, S. D. Russell, A. S. Shah, and J. V. Conte Creation of a Quantitative Recipient Risk Index for Mortality Prediction After Cardiac Transplantation (IMPACT) Ann. Thorac. Surg., September 1, 2011; 92(3): 914 - 922. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. J. McNulty, W. Ng, J. A. Spertus, J. G. Zaroff, R. W. Yeh, X. M. Ren, and R. J. Lundstrom Surgical Candidacy and Selection Biases in Nonemergent Left Main Stenting: Implications for Observational Studies J. Am. Coll. Cardiol. Intv., September 1, 2011; 4(9): 1020 - 1027. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. R. Akar, M. Kurtcephe, E. Sener, C. Alhan, S. Durdu, A. G. Kunt, H. A. Guvenir, and The working Group for the Turkish Society of Cardi Validation of the EuroSCORE risk models in Turkish adult cardiac surgical population Eur J Cardiothorac Surg, September 1, 2011; 40(3): 730 - 735. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. M. Shahian, F. H. Edwards, J. P. Jacobs, R. L. Prager, S.-L. T. Normand, C. M. Shewan, S. M. O'Brien, E. D. Peterson, and F. L. Grover Public reporting of cardiac surgery performance: part 2-implementation. Ann. Thorac. Surg., September 1, 2011; 92(3 Suppl): S12 - S23. [Abstract] [Full Text] [PDF] |
||||
![]() |
W. A. Ahmed, P. J. Tully, J. L. Knight, and R. A. Baker Female Sex as an Independent Predictor of Morbidity and Survival After Isolated Coronary Artery Bypass Grafting Ann. Thorac. Surg., July 1, 2011; 92(1): 59 - 67. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. J. London Do Let the Blood Pressure Fall: But Maybe Not So Much or So Often Anesth. Analg., July 1, 2011; 113(1): 7 - 9. [Full Text] [PDF] |
||||
![]() |
K. L. Greason, L. Englberger, R. M. Suri, S. J. Park, C. S. Rihal, S. V. Pislaru, and H. V. Schaff Safety of Same-Day Coronary Angiography in Patients Undergoing Elective Aortic Valve Replacement Ann. Thorac. Surg., June 1, 2011; 91(6): 1791 - 1796. [Abstract] [Full Text] [PDF] |
||||
![]() |
N. Bonaros, D. Vill, D. Wiedemann, K. Fischler, G. Friedrich, O. Pachinger, M. Grimm, and T. Schachner Major risk stratification models do not predict perioperative outcome after coronary artery bypass grafting in patients with previous percutaneous intervention Eur J Cardiothorac Surg, June 1, 2011; 39(6): e164 - e169. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. J. Tully, H. R. Winefield, R. A. Baker, D. A. Turnbull, and P. de Jonge Confirmatory factor analysis of the Beck Depression Inventory-II and the association with cardiac morbidity and mortality after coronary revascularization J Health Psychol, May 1, 2011; 16(4): 584 - 595. [Abstract] [PDF] |
||||
![]() |
H. Miyata, N. Motomura, H. Tsukihara, S. Takamoto, and Japan Cardiovascular Surgery Database Risk models including high-risk cardiovascular procedures: clinical predictors of mortality and morbidity Eur J Cardiothorac Surg, May 1, 2011; 39(5): 667 - 674. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. van Gameren, L. M. Putman, J. J. M. Takkenberg, and A. J. J. C. Bogers Risk stratification for adult congenital heart surgery Eur J Cardiothorac Surg, April 1, 2011; 39(4): 490 - 494. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. B. O'Blenes, C. H. Friesen, A. Ali, and S. Howlett Protecting the aged heart during cardiac surgery: The potential benefits of del Nido cardioplegia J. Thorac. Cardiovasc. Surg., March 1, 2011; 141(3): 762 - 770. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Miceli, V. D. Bruno, R. Capoun, F. Romeo, G. D. Angelini, and M. Caputo Occult renal dysfunction: a mortality and morbidity risk factor in coronary artery bypass grafting surgery J. Thorac. Cardiovasc. Surg., March 1, 2011; 141(3): 771 - 776. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. M. Bhamidipati, D. J. LaPar, G. J. Stukenborg, C. C. Morrison, J. A. Kern, I. L. Kron, and G. Ailawadi Superiority of moderate control of hyperglycemia to tight control in patients undergoing coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., February 1, 2011; 141(2): 543 - 551. [Abstract] [Full Text] [PDF] |
||||
![]() |
L. J. Dacey, J. H. Braxton Jr, R. S. Kramer, J. D. Schmoker, D. C. Charlesworth, R. E. Helm, C. Frumiento, G. L. Sardella, R. A. Clough, S. R. Jones, et al. Long-Term Outcomes of Endoscopic Vein Harvesting After Coronary Artery Bypass Grafting Circulation, January 18, 2011; 123(2): 147 - 153. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. B. Williams, E. R. DeLong, E. D. Peterson, R. S. Dokholyan, F.-S. Ou, T. B. Ferguson Jr, and for the Society of Thoracic Surgeons and the Natio Secondary Prevention After Coronary Artery Bypass Graft Surgery: Findings of a National Randomized Controlled Trial and Sustained Society-Led Incorporation Into Practice Circulation, January 4, 2011; 123(1): 39 - 45. [Abstract] [Full Text] [PDF] |
||||
![]() |
N. M. Katz The evolution of cardiothoracic critical care. J. Thorac. Cardiovasc. Surg., January 1, 2011; 141(1): 3 - 6. [Full Text] [PDF] |
||||
![]() |
D. M. Shahian, F. Edwards, F. L. Grover, J. P. Jacobs, C. D. Wright, R. L. Prager, J. B. Rich, M. J. Mack, and D. J. Mathisen The Society of Thoracic Surgeons National Adult Cardiac Database: A continuing commitment to excellence J. Thorac. Cardiovasc. Surg., November 1, 2010; 140(5): 955 - 959. [Full Text] [PDF] |
||||
![]() |
P. Ariyaratnam, M. Bland, and M. Loubani Risk factors and mortality associated with deep sternal wound infections following coronary bypass surgery with or without concomitant procedures in a UK population: a basis for a new risk model? Interact CardioVasc Thorac Surg, November 1, 2010; 11(5): 543 - 546. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Bennett-Guerrero, Y. Zhao, S. M. O'Brien, T. B. Ferguson Jr, E. D. Peterson, J. S. Gammie, and H. K. Song Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery JAMA, October 13, 2010; 304(14): 1568 - 1575. [Abstract] [Full Text] [PDF] |
||||
![]() |
Developed with the special contribution of the Eur, Authors/Task Force Members, W. Wijns, P. Kolh, N. Danchin, C. Di Mario, V. Falk, T. Folliguet, S. Garg, K. Huber, et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur. Heart J., October 2, 2010; 31(20): 2501 - 2555. [Full Text] [PDF] |
||||
![]() |
S. Garg, G. W. Stone, A.-P. Kappetein, J. F. Sabik III, C. Simonton, and P. W. Serruys Clinical and Angiographic Risk Assessment in Patients With Left Main Stem Lesions J. Am. Coll. Cardiol. Intv., September 1, 2010; 3(9): 891 - 901. [Abstract] [Full Text] [PDF] |
||||
![]() |
The Task Force on Myocardial Revascularization of Guidelines on myocardial revascularization Eur J Cardiothorac Surg, September 1, 2010; 38(Supplement_1): S1 - S52. [Full Text] [PDF] |
||||
![]() |
S. Bramer, A. H. M. van Straten, M. A. Soliman Hamad, E. Berreklouw, E. J. Martens, and J. G. Maessen The Impact of New-Onset Postoperative Atrial Fibrillation on Mortality After Coronary Artery Bypass Grafting Ann. Thorac. Surg., August 1, 2010; 90(2): 443 - 449. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Jin, A. P. Furnary, S. C. Fine, E. H. Blackstone, and G. L. Grunkemeier Using Society of Thoracic Surgeons Risk Models for Risk-Adjusting Cardiac Surgery Results Ann. Thorac. Surg., March 1, 2010; 89(3): 677 - 682. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Saso, D. James, J. A. Vecht, E. Kidher, J. Kokotsakis, V. Malinovski, C. Rao, A. Darzi, J. R. Anderson, and T. Athanasiou Effect of Skeletonization of the Internal Thoracic Artery for Coronary Revascularization on the Incidence of Sternal Wound Infection Ann. Thorac. Surg., February 1, 2010; 89(2): 661 - 670. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. M. Shahian, S. M. O'Brien, S.-L. T. Normand, E. D. Peterson, and F. H. Edwards Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score J. Thorac. Cardiovasc. Surg., February 1, 2010; 139(2): 273 - 282. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. L. Rohde, R. A. Baker, P. J. Tully, S. Graham, H. Cullen, and J. L. Knight Preoperative and Intraoperative Factors Associated With Long-Term Survival in Octogenarian Cardiac Surgery Patients Ann. Thorac. Surg., January 1, 2010; 89(1): 105 - 111. [Abstract] [Full Text] [PDF] |
||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |