Clinical prediction model suitable for assessing hospital quality for patients undergoing carotid endarterectomy.

Abstract

BACKGROUND:

Assessing hospital quality in the performance of carotid endarterectomy (CEA) requires appropriate risk adjustment across hospitals with varying case mixes. The aim of this study was to develop and validate a prediction model to assess the risk of in-hospital stroke or death after CEA that could aid in the assessment of hospital quality.

METHODS AND RESULTS:

Patients from National Cardiovascular Data Registry (NCDR)'s Carotid Artery Revascularization and Endarterectomy (CARE) Registry undergoing CEA without acute evolving stroke from 2005 to 2013 were included. In-hospital stroke or death was modeled using hierarchical logistic regression with 20 candidate variables and accounting for hospital-level clustering. Internal validation was achieved with bootstrapping; model discrimination and calibration were assessed. A total of 213 (1.7%) primary end point events occurred during 12 889 procedures. Independent predictors of stroke or death included age, prior peripheral artery disease, diabetes mellitus, prior coronary artery disease, having a symptomatic carotid lesion, having a contralateral carotid occlusion, or having New York Heart Association Class III or IV heart failure. The model was well calibrated and demonstrated moderate discriminative ability (c-statistic 0.65). The NCDR CEA score was then developed to support simple, prospective risk quantification in the clinical setting.

CONCLUSIONS:

The NCDR CEA score, comprising 7 clinical variables, predicts in-hospital stroke or death after CEA. This model can be used to estimate hospital risk-adjusted outcomes for CEA and to assist with the assessment of hospital quality.

• Authors: Neil J Wimmer, John A Spertus, Kevin F Kennedy, H Vernon Anderson, Jeptha P Curtis, William S Weintraub, Mandeep Singh, John S Rumsfeld, Frederick A Masoudi, Robert W Yeh
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 3 Issue 3 Pg. e000728 (Jun 17 2014) ISSN: 2047-9980 [Electronic] England
• PMID: 24938712 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Endarterectomy, Carotid (mortality, standards, statistics & numerical data)
• Female
• Hospitals (standards, statistics & numerical data)
• Humans
• Logistic Models
• Male
• Models, Statistical
• Quality Assurance, Health Care (methods, statistics & numerical data)
• Registries
• Stroke (epidemiology, prevention & control)
• United States (epidemiology)