The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions

Graeme K Ambler; Manjit S Gohel; David C Mitchell; Ian M Loftus; Jonathan R Boyle; Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland

doi:10.1016/j.jvs.2014.06.002

The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions

Graeme K Ambler, Manjit S Gohel, David C Mitchell, Ian M Loftus, Jonathan R Boyle, Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

BACKGROUND: Accurate adjustment of surgical outcome data for risk is vital in an era of surgeon-level reporting. Current risk prediction models for abdominal aortic aneurysm (AAA) repair are suboptimal. We aimed to develop a reliable risk model for in-hospital mortality after intervention for AAA, using rigorous contemporary statistical techniques to handle missing data.

METHODS: Using data collected during a 15-month period in the United Kingdom National Vascular Database, we applied multiple imputation methodology together with stepwise model selection to generate preoperative and perioperative models of in-hospital mortality after AAA repair, using two thirds of the available data. Model performance was then assessed on the remaining third of the data by receiver operating characteristic curve analysis and compared with existing risk prediction models. Model calibration was assessed by Hosmer-Lemeshow analysis.

RESULTS: A total of 8088 AAA repair operations were recorded in the National Vascular Database during the study period, of which 5870 (72.6%) were elective procedures. Both preoperative and perioperative models showed excellent discrimination, with areas under the receiver operating characteristic curve of .89 and .92, respectively. This was significantly better than any of the existing models (area under the receiver operating characteristic curve for best comparator model, .84 and .88; P < .001 and P = .001, respectively). Discrimination remained excellent when only elective procedures were considered. There was no evidence of miscalibration by Hosmer-Lemeshow analysis.

CONCLUSIONS: We have developed accurate models to assess risk of in-hospital mortality after AAA repair. These models were carefully developed with rigorous statistical methodology and significantly outperform existing methods for both elective cases and overall AAA mortality. These models will be invaluable for both preoperative patient counseling and accurate risk adjustment of published outcome data.

Original language	English
Pages (from-to)	35-43
Number of pages	9
Journal	Journal of Vascular Surgery
Volume	61
Issue number	1
Early online date	28 Jun 2014
DOIs	https://doi.org/10.1016/j.jvs.2014.06.002
Publication status	Published - Jan 2015

Keywords

Aortic Aneurysm, Abdominal/diagnosis
Area Under Curve
Blood Vessel Prosthesis Implantation/adverse effects
Databases, Factual
Decision Support Techniques
Discriminant Analysis
Elective Surgical Procedures
Endovascular Procedures/adverse effects
Hospital Mortality
Humans
Patient Selection
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Risk Assessment
Risk Factors
Treatment Outcome
United States

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Dr Graeme K Ambler
- graeme.ambler@bristol.ac.uk
- Bristol Medical School (PHS) - Clinical Lecturer
Person: Academic

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Ambler, G. K., Gohel, M. S., Mitchell, D. C., Loftus, I. M., Boyle, J. R., & Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland (2015). The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions. Journal of Vascular Surgery, 61(1), 35-43. https://doi.org/10.1016/j.jvs.2014.06.002

Ambler, Graeme K ; Gohel, Manjit S ; Mitchell, David C ; Loftus, Ian M ; Boyle, Jonathan R ; Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland. / The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions. In: Journal of Vascular Surgery. 2015 ; Vol. 61, No. 1. pp. 35-43.

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title = "The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions",

abstract = "BACKGROUND: Accurate adjustment of surgical outcome data for risk is vital in an era of surgeon-level reporting. Current risk prediction models for abdominal aortic aneurysm (AAA) repair are suboptimal. We aimed to develop a reliable risk model for in-hospital mortality after intervention for AAA, using rigorous contemporary statistical techniques to handle missing data.METHODS: Using data collected during a 15-month period in the United Kingdom National Vascular Database, we applied multiple imputation methodology together with stepwise model selection to generate preoperative and perioperative models of in-hospital mortality after AAA repair, using two thirds of the available data. Model performance was then assessed on the remaining third of the data by receiver operating characteristic curve analysis and compared with existing risk prediction models. Model calibration was assessed by Hosmer-Lemeshow analysis.RESULTS: A total of 8088 AAA repair operations were recorded in the National Vascular Database during the study period, of which 5870 (72.6%) were elective procedures. Both preoperative and perioperative models showed excellent discrimination, with areas under the receiver operating characteristic curve of .89 and .92, respectively. This was significantly better than any of the existing models (area under the receiver operating characteristic curve for best comparator model, .84 and .88; P < .001 and P = .001, respectively). Discrimination remained excellent when only elective procedures were considered. There was no evidence of miscalibration by Hosmer-Lemeshow analysis.CONCLUSIONS: We have developed accurate models to assess risk of in-hospital mortality after AAA repair. These models were carefully developed with rigorous statistical methodology and significantly outperform existing methods for both elective cases and overall AAA mortality. These models will be invaluable for both preoperative patient counseling and accurate risk adjustment of published outcome data.",

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author = "Ambler, {Graeme K} and Gohel, {Manjit S} and Mitchell, {David C} and Loftus, {Ian M} and Boyle, {Jonathan R} and {Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland}",

year = "2015",

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language = "English",

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journal = "Journal of Vascular Surgery",

issn = "0741-5214",

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Ambler, GK, Gohel, MS, Mitchell, DC, Loftus, IM, Boyle, JR & Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland 2015, 'The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions', Journal of Vascular Surgery, vol. 61, no. 1, pp. 35-43. https://doi.org/10.1016/j.jvs.2014.06.002

The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions. / Ambler, Graeme K; Gohel, Manjit S; Mitchell, David C; Loftus, Ian M; Boyle, Jonathan R; Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland.

In: Journal of Vascular Surgery, Vol. 61, No. 1, 01.2015, p. 35-43.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions

AU - Ambler, Graeme K

AU - Gohel, Manjit S

AU - Mitchell, David C

AU - Loftus, Ian M

AU - Boyle, Jonathan R

AU - Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland

PY - 2015/1

Y1 - 2015/1

N2 - BACKGROUND: Accurate adjustment of surgical outcome data for risk is vital in an era of surgeon-level reporting. Current risk prediction models for abdominal aortic aneurysm (AAA) repair are suboptimal. We aimed to develop a reliable risk model for in-hospital mortality after intervention for AAA, using rigorous contemporary statistical techniques to handle missing data.METHODS: Using data collected during a 15-month period in the United Kingdom National Vascular Database, we applied multiple imputation methodology together with stepwise model selection to generate preoperative and perioperative models of in-hospital mortality after AAA repair, using two thirds of the available data. Model performance was then assessed on the remaining third of the data by receiver operating characteristic curve analysis and compared with existing risk prediction models. Model calibration was assessed by Hosmer-Lemeshow analysis.RESULTS: A total of 8088 AAA repair operations were recorded in the National Vascular Database during the study period, of which 5870 (72.6%) were elective procedures. Both preoperative and perioperative models showed excellent discrimination, with areas under the receiver operating characteristic curve of .89 and .92, respectively. This was significantly better than any of the existing models (area under the receiver operating characteristic curve for best comparator model, .84 and .88; P < .001 and P = .001, respectively). Discrimination remained excellent when only elective procedures were considered. There was no evidence of miscalibration by Hosmer-Lemeshow analysis.CONCLUSIONS: We have developed accurate models to assess risk of in-hospital mortality after AAA repair. These models were carefully developed with rigorous statistical methodology and significantly outperform existing methods for both elective cases and overall AAA mortality. These models will be invaluable for both preoperative patient counseling and accurate risk adjustment of published outcome data.

AB - BACKGROUND: Accurate adjustment of surgical outcome data for risk is vital in an era of surgeon-level reporting. Current risk prediction models for abdominal aortic aneurysm (AAA) repair are suboptimal. We aimed to develop a reliable risk model for in-hospital mortality after intervention for AAA, using rigorous contemporary statistical techniques to handle missing data.METHODS: Using data collected during a 15-month period in the United Kingdom National Vascular Database, we applied multiple imputation methodology together with stepwise model selection to generate preoperative and perioperative models of in-hospital mortality after AAA repair, using two thirds of the available data. Model performance was then assessed on the remaining third of the data by receiver operating characteristic curve analysis and compared with existing risk prediction models. Model calibration was assessed by Hosmer-Lemeshow analysis.RESULTS: A total of 8088 AAA repair operations were recorded in the National Vascular Database during the study period, of which 5870 (72.6%) were elective procedures. Both preoperative and perioperative models showed excellent discrimination, with areas under the receiver operating characteristic curve of .89 and .92, respectively. This was significantly better than any of the existing models (area under the receiver operating characteristic curve for best comparator model, .84 and .88; P < .001 and P = .001, respectively). Discrimination remained excellent when only elective procedures were considered. There was no evidence of miscalibration by Hosmer-Lemeshow analysis.CONCLUSIONS: We have developed accurate models to assess risk of in-hospital mortality after AAA repair. These models were carefully developed with rigorous statistical methodology and significantly outperform existing methods for both elective cases and overall AAA mortality. These models will be invaluable for both preoperative patient counseling and accurate risk adjustment of published outcome data.

KW - Aortic Aneurysm, Abdominal/diagnosis

KW - Area Under Curve

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Databases, Factual

KW - Decision Support Techniques

KW - Discriminant Analysis

KW - Elective Surgical Procedures

KW - Endovascular Procedures/adverse effects

KW - Hospital Mortality

KW - Humans

KW - Patient Selection

KW - Predictive Value of Tests

KW - ROC Curve

KW - Reproducibility of Results

KW - Risk Assessment

KW - Risk Factors

KW - Treatment Outcome

KW - United States

U2 - 10.1016/j.jvs.2014.06.002

DO - 10.1016/j.jvs.2014.06.002

M3 - Article (Academic Journal)

C2 - 24985535

VL - 61

SP - 35

EP - 43

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 1

ER -

Ambler GK, Gohel MS, Mitchell DC, Loftus IM, Boyle JR, Audit and Quality Improvement Committee of the Vascular Society of Great Britain and Ireland. The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions. Journal of Vascular Surgery. 2015 Jan;61(1):35-43. https://doi.org/10.1016/j.jvs.2014.06.002

The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions

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Dr Graeme K Ambler

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