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Thorac Cardiovasc Surg 2014; 62(04): 276-287
DOI: 10.1055/s-0033-1364193
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

German CABG Score: A Specific Risk Model for Patients Undergoing Isolated Coronary Artery Bypass Grafting

Joachim Kötting
1   BQS Institute for Quality and Patient Safety, Düsseldorf, North Rhine-Westphalia, Germany
,
Andreas Beckmann
2   Department of Cardiac and Vascular Surgery, Heart Center Duisburg, Duisburg, North Rhine-Westphalia, Germany
,
Klaus Döbler
3   Competence Center for Quality Management, MDK Baden-Württemberg, Stuttgart, Baden-Württemberg, Germany
,
Elke Schäfer
1   BQS Institute for Quality and Patient Safety, Düsseldorf, North Rhine-Westphalia, Germany
,
Christof Veit
1   BQS Institute for Quality and Patient Safety, Düsseldorf, North Rhine-Westphalia, Germany
,
Armin Welz
4   Department of Cardiac Surgery, University of Bonn, Bonn, North Rhine-Westphalia, Germany
,
Wolfgang Schiller
4   Department of Cardiac Surgery, University of Bonn, Bonn, North Rhine-Westphalia, Germany
› Author Affiliations
Further Information

Publication History

17 July 2013

14 November 2013

Publication Date:
27 February 2014 (online)

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Abstract

Background A specific risk model concerning mortality of patients undergoing isolated coronary artery bypass grafting (CABG) is developed based on the national quality benchmarking mandatory by law in Germany.

Methods On the basis of the national data pool from 2004, a risk score model for patients undergoing isolated CABG was developed and finally adjusted with the data of 43,145 patients of the year 2008. Modeling was performed by logistic regression analysis. This risk model was validated with the 2007 data pool which comprised 45,569 patients.

Results Observed in-hospital mortality after isolated CABG procedures was 3.0% in 2008. Hosmer–Lemeshow test p value was 0.189 and area under receiver operating characteristic curve was 0.826. Applying the German CABG score for 2007 resulted in an observed-to-expected mortality ratio of 1.01.

Conclusion The German CABG score for in-hospital mortality is a risk score with proven validity for isolated CABG, developed by means of the patient population in Germany. It can be used for the assessment of patient risk groups and for interhospital benchmarking. We encourage other researchers to apply and validate this score in comparable health care systems.

Keywords

in-hospital mortality - risk factors - CABG - risk adjustment

Note

Joachim Kötting and Andreas Beckmann contributed equally to this work. Joachim Kötting provided his expertise in methodology and developed the score. Andreas Beckmann is responsible for the medical background of the model and the contributions associated therewith.


 

  • References

  • 1 Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16 (1) 9-13
    CrossrefPubMedGoogle Scholar
  • 2 Hannan EL, Kilburn Jr H, O'Donnell JF, Lukacik G, Shields EP. Adult open heart surgery in New York State. An analysis of risk factors and hospital mortality rates. JAMA 1990; 264 (21) 2768-2774
    CrossrefPubMedGoogle Scholar
  • 3 Grover FL, Shroyer AL, Hammermeister KE. Calculating risk and outcome: the Veterans Affairs database. Ann Thorac Surg 1996; 62 (5, Suppl): S6-S11 , discussion S31–S32
    CrossrefPubMedGoogle Scholar
  • 4 Kouchoukos NT, Ebert PA, Grover FL, Lindesmith GG. Report of the Ad Hoc Committee on Risk Factors for Coronary Artery Bypass Surgery. Ann Thorac Surg 1988; 45 (3) 348-349
    CrossrefPubMedGoogle Scholar
  • 5 Clark RE. It is time for a national cardiothoracic surgical data base. Ann Thorac Surg 1989; 48 (6) 755-756
    CrossrefPubMedGoogle Scholar
  • 6 Shahian DM, O'Brien SM, Filardo G , et al; Society of Thoracic Surgeons Quality Measurement Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1—coronary artery bypass grafting surgery. Ann Thorac Surg 2009; 88 (1, Suppl): S2-S22
    CrossrefPubMedGoogle Scholar
  • 7 O'Brien SM, Shahian DM, Filardo G , et al; Society of Thoracic Surgeons Quality Measurement Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery. Ann Thorac Surg 2009; 88 (1, Suppl): S23-S42
    CrossrefPubMedGoogle Scholar
  • 8 Shahian DM, O'Brien SM, Filardo G , et al; Society of Thoracic Surgeons Quality Measurement Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3—valve plus coronary artery bypass grafting surgery. Ann Thorac Surg 2009; 88 (1, Suppl): S43-S62
    CrossrefPubMedGoogle Scholar
  • 9 Roques F, Nashef SA, Michel P , et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999; 15 (6) 816-822 , discussion 822–823
    CrossrefPubMedGoogle Scholar
  • 10 Michel P, Roques F, Nashef SA ; EuroSCORE Project Group. Logistic or additive EuroSCORE for high-risk patients?. Eur J Cardiothorac Surg 2003; 23 (5) 684-687, discussion 687
    CrossrefPubMedGoogle Scholar
  • 11 D'Errigo P, Seccareccia F, Rosato S , et al; Research Group of the Italian CABG Outcome Project. Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project. Eur J Cardiothorac Surg 2008; 33 (3) 325-333
    CrossrefPubMedGoogle Scholar
  • 12 Gummert JF, Funkat A, Osswald B , et al. EuroSCORE overestimates the risk of cardiac surgery: results from the national registry of the German Society of Thoracic and Cardiovascular Surgery. Clin Res Cardiol 2009; 98 (6) 363-369
    CrossrefPubMedGoogle Scholar
  • 13 Nashef SA, Roques F, Sharples LD , et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41 (4) 734-744 , discussion 744–745
    CrossrefPubMedGoogle Scholar
  • 14 Hosmer D, Lemeshow S. A goodness-of-fit test for the multiple logistic regression model. Commun Stat A-Theor 1980; A10: 1043-1069
    PubMedGoogle Scholar
  • 15 Sergeant P, Meuris B, Pettinari M. EuroSCORE II, illum qui est gravitates magni observe. Eur J Cardiothorac Surg 2012; 41 (4) 729-731
    CrossrefPubMedGoogle Scholar
  • 16 Carnero-Alcázar M, Silva Guisasola JA, Reguillo Lacruz FJ , et al. Validation of EuroSCORE II on a single-centre 3800 patient cohort. Interact Cardiovasc Thorac Surg 2013; 16 (3) 293-300
    CrossrefPubMedGoogle Scholar
  • 17 Hickey GL, Grant SW, Bridgewater B. Validation of the EuroSCORE II: should we be concerned with retrospective performance?. Eur J Cardiothorac Surg 2013; 43 (3) 655
    CrossrefPubMedGoogle Scholar
  • 18 Collins GS, Altman DG. Design flaws in EuroSCORE II. Eur J Cardiothorac Surg 2013; 43 (4) 871
    CrossrefPubMedGoogle Scholar
  • 19 Gummert JF, Funkat A, Beckmann A , et al. Cardiac surgery in Germany during 2008. A report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2009; 57 (6) 315-323
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Gitt AK, Bueno H, Danchin N , et al. The role of cardiac registries in evidence-based medicine. Eur Heart J 2010; 31 (5) 525-529
    CrossrefPubMedGoogle Scholar
  • 21 Rankin JS, He X, O'Brien SM , et al. The Society of Thoracic Surgeons risk model for operative mortality after multiple valve surgery. Ann Thorac Surg 2013; 95 (4) 1484-1490
    CrossrefPubMedGoogle Scholar
  • 22 Hannan EL, Farrell LS, Wechsler A , et al. The New York risk score for in-hospital and 30-day mortality for coronary artery bypass graft surgery. Ann Thorac Surg 2013; 95 (1) 46-52
    CrossrefPubMedGoogle Scholar
  • 23 Hannan EL, Racz M, Culliford AT , et al. Risk score for predicting in-hospital/30-day mortality for patients undergoing valve and valve/coronary artery bypass graft surgery. Ann Thorac Surg 2013; 95 (4) 1282-1290
    CrossrefPubMedGoogle Scholar
  • 24 Kötting J, Schiller W, Beckmann A , et al. German Aortic Valve Score: a new scoring system for prediction of mortality related to aortic valve procedures in adults. Eur J Cardiothorac Surg 2013; 43 (5) 971-977
    CrossrefPubMedGoogle Scholar
  • 25 Bridgewater B, Neve H, Moat N, Hooper T, Jones M. Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms. Heart 1998; 79 (4) 350-355
    CrossrefPubMedGoogle Scholar
  • 26 Shahian DM, Blackstone EH, Edwards FH , et al; STS workforce on evidence-based surgery. Cardiac surgery risk models: a position article. Ann Thorac Surg 2004; 78 (5) 1868-1877
    CrossrefPubMedGoogle Scholar