Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida.
Ann Thorac Surg. 2018 May;105(5):1411-1418. doi: 10.1016/j.athoracsur.2018.03.002. Epub 2018 Mar 22.
The last published version of The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) risk models were developed in 2008 based on patient data from 2002 to 2006 and have been periodically recalibrated. In response to evolving changes in patient characteristics, risk profiles, surgical practice, and outcomes, the STS has now developed a set of entirely new risk models for adult cardiac surgery.
New models were estimated for isolated coronary artery bypass grafting surgery (CABG [n = 439,092]), isolated aortic or mitral valve surgery (n = 150,150), and combined valve plus CABG procedures (n = 81,588). The development set was based on July 2011 to June 2014 STS ACSD data; validation was performed using July 2014 to December 2016 data. Separate models were developed for operative mortality, stroke, renal failure, prolonged ventilation, reoperation, composite major morbidity or mortality, and prolonged or short postoperative length of stay. Because of its low occurrence rate, a combined model incorporating all operative types was developed for deep sternal wound infection/mediastinitis.
Calibration was excellent except for the deep sternal wound infection/mediastinitis model, which slightly underestimated risk because of higher rates of this endpoint in the more recent validation data; this will be recalibrated in each feedback report. Discrimination (c-index) of all models was superior to that of 2008 models except for the stroke model for valve patients.
Completely new STS ACSD risk models have been developed based on contemporary patient data; their performance is superior to that of previous STS ACSD models.
美国胸外科医师学会（STS）成人心脏手术数据库（ACSD）的最后一个发布版本是基于 2002 年至 2006 年的患者数据，于 2008 年开发的，并已定期重新校准。为了应对患者特征、风险状况、手术实践和结果的不断变化，STS 现在为成人心脏手术开发了一套全新的风险模型。
新模型是针对单纯冠状动脉旁路移植术（CABG [n=439092]）、单纯主动脉瓣或二尖瓣手术（n=150150）和联合瓣膜加 CABG 手术（n=81588）进行估计的。开发集基于 2011 年 7 月至 2014 年 6 月 STS ACSD 数据；验证是使用 2014 年 7 月至 2016 年 12 月的数据进行的。分别为手术死亡率、中风、肾衰竭、长时间通气、再次手术、复合主要发病率或死亡率以及术后住院时间延长或缩短开发了单独的模型。由于深部胸骨伤口感染/纵隔炎的发生率较低，因此为所有手术类型开发了一个联合模型。
除深部胸骨伤口感染/纵隔炎模型外，校准效果良好，这是由于最近验证数据中该终点的发生率较高，该模型略微低估了风险；这将在每个反馈报告中进行重新校准。除瓣膜患者的中风模型外，所有模型的判别能力（c 指数）均优于 2008 年的模型。
基于当代患者数据，已经开发出全新的 STS ACSD 风险模型；它们的性能优于之前的 STS ACSD 模型。
