Motomura Noboru, Miyata Hiroaki, Tsukihara Hiroyuki, Okada Masafumi, Takamoto Shinichi
Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Ann Thorac Surg. 2008 Dec;86(6):1866-72. doi: 10.1016/j.athoracsur.2008.08.001.
Risk models of coronary artery bypass grafting (CABG) using a large database are useful for improving surgical quality. To obtain accurate, high-quality assessments of the surgical outcomes, each country should maintain its own database. This study was conducted to collect Japanese data and prepare a risk stratification of isolated CABG procedures using the Japan Adult Cardiovascular Surgery Database (JACVSD).
We analyzed 7133 CABG-only records from 97 participating sites throughout Japan using a data entry form with 255 variables that was sent to the JACVSD office by our Web-based data collection system. The statistical model was constructed by multiple logistic regression. Model discrimination was tested using the area under the receiver operating characteristic curve (C index). Model calibration was tested by the Hosmer-Lemeshow test.
Of 7133 operations, 47.2% had diabetes mellitus, 14.0% were urgent, and 15.6% involved peripheral vascular disease. The observed 30-day and operative mortality rates were 2.02% and 2.72%, respectively. Significant variables with high odds ratios included emergency or salvage status (3.71), preoperative creatinine value exceeding 3.0 mg/dL (3.59), aortic valve stenosis (3.01), and moderate to severe chronic lung disease (2.86). Hosmer-Lemeshow test and C-index values for 30-day mortality were satisfactory at 0.96 and 0.85, respectively.
The results obtained in Japan were at least as good as those reported elsewhere. The performance of our risk model also matched those of the Society of Thoracic Surgeons National Adult Cardiac Database and the European Society Database.
利用大型数据库建立冠状动脉旁路移植术（CABG）风险模型，有助于提高手术质量。为了获得准确、高质量的手术结果评估，每个国家都应维护自己的数据库。本研究旨在收集日本的数据，并利用日本成人心血管外科数据库（JACVSD）对单纯CABG手术进行风险分层。
我们使用一个包含255个变量的数据录入表格，通过基于网络的数据收集系统将其发送至JACVSD办公室，分析了日本全国97个参与研究的机构提供的7133例单纯CABG记录。通过多重逻辑回归构建统计模型。使用受试者工作特征曲线下面积（C指数）检验模型的辨别能力。通过Hosmer-Lemeshow检验对模型校准进行测试。
在7133例手术中，47.2%的患者患有糖尿病，14.0%为急诊手术，15.6%涉及外周血管疾病。观察到的30天和手术死亡率分别为2.02%和2.72%。高比值比的显著变量包括急诊或抢救状态（3.71）、术前肌酐值超过3.0mg/dL（3.59）、主动脉瓣狭窄（3.01）以及中度至重度慢性肺病（2.86）。30天死亡率的Hosmer-Lemeshow检验和C指数值分别为0.96和0.85，结果令人满意。
在日本获得的结果至少与其他地方报道的结果一样好。我们风险模型的性能也与胸外科医师协会国家成人心脏数据库和欧洲协会数据库的性能相当。
