Alan D Bernstein, Victor Parsonnet, MD The Annals of Thoracic Surgery

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Presentation transcript:

Bedside estimation of risk as an aid for decision-making in cardiac surgery Alan D Bernstein, Victor Parsonnet, MD The Annals of Thoracic Surgery Volume 69, Issue 3, Pages 823-828 (March 2000) DOI: 10.1016/S0003-4975(99)01424-1

Fig 1 Expected (○) and observed (•) mortality rates with 95% binomial confidence limits for aortocoronary bypass, valve, and combination procedures performed in 1994 and 1995 at 10 New Jersey hospitals. The risk ranges shown are used only for comparison of observed and estimated mortality rates. No ranges were involved in deriving the approximate model described in the text. (O/E = ratio of observed to expected mortality rates.) The Annals of Thoracic Surgery 2000 69, 823-828DOI: (10.1016/S0003-4975(99)01424-1)

Fig 2 Form for use in preoperative estimation of surgical risk. (A) Front; (B) Back. A similar worksheet derived from more recent (1996–1997) data may be obtained from the authors. (ACB = aortocoronary bypass; COPD = chronic obstructive pulmonary disease; CVA = cerebrovascular accident; IABP = intraaortic balloon pump; LV = left-ventricular; MI = myocardial infarction; PTCA = percutaneous transluminal coronary angioplasty.) The Annals of Thoracic Surgery 2000 69, 823-828DOI: (10.1016/S0003-4975(99)01424-1)

Fig 2 Form for use in preoperative estimation of surgical risk. (A) Front; (B) Back. A similar worksheet derived from more recent (1996–1997) data may be obtained from the authors. (ACB = aortocoronary bypass; COPD = chronic obstructive pulmonary disease; CVA = cerebrovascular accident; IABP = intraaortic balloon pump; LV = left-ventricular; MI = myocardial infarction; PTCA = percutaneous transluminal coronary angioplasty.) The Annals of Thoracic Surgery 2000 69, 823-828DOI: (10.1016/S0003-4975(99)01424-1)

Fig 3 Example of the use of the bedside form: calculation of a patient’s total score. (ACB = aortocoronary bypass; COPD = chronic obstructive pulmonary disease; IABP = intraaortic balloon pump.) The Annals of Thoracic Surgery 2000 69, 823-828DOI: (10.1016/S0003-4975(99)01424-1)

Fig 4 Detail showing how to determine the estimated risk (vertical axis, approximately 2.5% to 3.5%) from the total score calculated by adding the appropriate risk-factor scores shown on the worksheet in Figure 3. The Annals of Thoracic Surgery 2000 69, 823-828DOI: (10.1016/S0003-4975(99)01424-1)

Fig 5 Scatter plot comparing the bedside approximation with System 97 estimates for 200 actual consecutive aortocoronary bypass procedures at a single hospital in 1996. The three outliers are addressed in Table 2. The Annals of Thoracic Surgery 2000 69, 823-828DOI: (10.1016/S0003-4975(99)01424-1)