Mortality after cardiac bypass surgery: Prediction from administrative versus clinical data

Jane M. Geraci, Michael L. Johnson, Howard S. Gordon, Nancy J. Petersen, A. Laurie Shroyer, Frederick L. Grover, Nelda Wray

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

Background: Risk-adjusted outcome rates frequently are used to make inferences about hospital quality of care. We calculated risk-adjusted mortality rates in veterans undergoing isolated coronary artery bypass surgery (CABS) from administrative data and from chart-based clinical data and compared the assessment of hospital high and low outlier status for mortality that results from these 2 data sources. Study Population: We studied veterans who underwent CABS in 43 VA hospitals between October 1, 1993, and March 30, 1996 (n = 15,288). Methods: To evaluate administrative data, we entered 6 groups of International Classification of Diseases (ICD)-9-CM codes for comorbid diagnoses from the VA Patient Treatment File (PTF) into a logistic regression model predicting postoperative mortality. We also evaluated counts of comorbid ICD-9-CM codes within each group, along with 3 common principal diagnoses, weekend admission or surgery, major procedures associated with CABS, and demographic variables. Data from the VA Continuous Improvement in Cardiac Surgery Program (CICSP) were used to create a separate clinical model predicting postoperative mortality. For each hospital, an observed-to-expected (O/E) ratio of mortality was calculated from (1) the PTF model and (2) the CICSP model. We defined outlier status as an O/E ratio outside of 1.0 (based on the hospital's 90% confidence interval). To improve the statistical and predictive power of the PTF model, selected clinical variables from CICSP were added to it and outlier status reassessed. Results: Significant predictors of postoperative mortality in the PTF model included 1 group of comorbid ICD-9-CM codes, intraortic balloon pump insertion before CABS, angioplasty on the day of or before CABS, weekend surgery, and a principal diagnosis of other forms of ischemic heart disease. The model's c-index was 0.698. As expected, the CICSP model's predictive power was significantly greater than that of the administrative model (c = 0.761). The addition of just 2 CICSP variables to the PTF model improved its predictive power (c = 0.741). This model identified 5 of 6 high mortality outliers identified by the CICSP model. Additional CICSP variables were statistically significant predictors but did not improve the assessment of high outlier status. Conclusions: Models using administrative data to predict postoperative mortality can be improved with the addition of a very small number of clinical variables. Limited clinical improvements of administrative data may make it suitable for use in quality improvement efforts.

Original languageEnglish (US)
Pages (from-to)149-158
Number of pages10
JournalMedical Care
Volume43
Issue number2
DOIs
StatePublished - Feb 2005

Keywords

  • Administrative data
  • Coronary artery bypass surgery
  • Mortality
  • Outlier
  • Risk adjustment

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

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