Comparison of Mortality Prediction Models after Open Abdominal Aortic Aneurysm Repair

V. G. Hadjianastassiou, P. P. Tekkis, T. Athanasiou, A. Muktadir, J. D. Young, L. J. Hands

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Comparison of the accuracy of prediction of contemporary mortality prediction models after open Abdominal Aortic Aneurysm (AAA) surgery. Methods: Post-operative data were collected from AAA patients from 2 UK Intensive Care Units (ICU). POSSUM and VBHOM based models were compared to the APACHE-AAA model which was able to adjust for the hospital-related effect on outcome. Model performance was assessed using measures of calibration, discrimination and subgroup analysis. Results: 541 patients were studied. The in-hospital mortality rate for elective AAA repair (325 patients) was: 6.2% (95% confidence interval (c.i.) 3.5 to 8.8) and for emergency repair (216 patients) was: 28.7% (95% c.i. 22.5-34.9). The APACHE-based model had the best overall fit to the whole population of AAA patients, and also separately in elective and emergency patients. The V-POSSUM physiology-only (p < 0.001) and VBHOM (p = 0.011) models had a poor fit in elective patients. The RAAA-POSSUM physiology-only (p < 0.001) and VBHOM models (p = 0.010) had a poor fit in emergency patients. Conclusions: The APACHE-AAA model with its ability to adjust for both the hospital-related "effect" as well as the patient case-mix, was a more accurate risk stratification model than other contemporary models, in the post-operative AAA patient managed in ICU.

Original languageEnglish
Pages (from-to)536-543
Number of pages8
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume33
Issue number5
DOIs
Publication statusPublished - May 2007

Keywords

  • Hospital mortality
  • Intensive care units
  • Models, Statistical
  • Prognosis
  • Severity of illness index

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