Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont.
CMAJ Open. 2022 Mar 8;10(1):E173-E182. doi: 10.9778/cmajo.20210031. Print 2022 Jan-Mar.
Surgical delay may result in unintended harm to patients needing cardiac surgery, who are at risk for death if their condition is left untreated. Our objective was to derive and internally validate a clinical risk score to predict death among patients awaiting major cardiac surgery.
We used the CorHealth Ontario Registry and linked ICES health administrative databases with information on all Ontario residents to identify patients aged 18 years or more who were referred for isolated coronary artery bypass grafting (CABG), valvular procedures, combined CABG-valvular procedures or thoracic aorta procedures between Oct. 1, 2008, and Sept. 30, 2019. We used a hybrid modelling approach with the random forest method for initial variable selection, followed by backward stepwise logistic regression modelling for clinical interpretability and parsimony. We internally validated the logistic regression model, termed the CardiOttawa Waitlist Mortality Score, using 200 bootstraps.
Of the 112 266 patients referred for cardiac surgery, 269 (0.2%) died while awaiting surgery (118/72 366 [0.2%] isolated CABG, 81/24 461 [0.3%] valvular procedures, 63/12 046 [0.5%] combined CABG-valvular procedures and 7/3393 [0.2%] thoracic aorta procedures). Age, sex, surgery type, left main stenosis, Canadian Cardiovascular Society classification, left ventricular ejection fraction, heart failure, atrial fibrillation, dialysis, psychosis and operative priority were predictors of waitlist mortality. The model discriminated (C-statistic 0.76 [optimism-corrected 0.73]). It calibrated well in the overall cohort (Hosmer-Lemeshow = 0.2) and across surgery types.
The CardiOttawa Waitlist Mortality Score is a simple clinical risk model that predicts the likelihood of death while awaiting cardiac surgery. It has the potential to provide data-driven decision support for managing access to cardiac care and preserve system capacity during the COVID-19 pandemic, the recovery period and beyond.
手术延迟可能会对需要心脏手术的患者造成意外伤害，如果不进行治疗，这些患者有死亡的风险。我们的目的是开发并内部验证一种临床风险评分，以预测等待大心脏手术的患者的死亡。
我们使用 CorHealth Ontario 注册中心和链接的安大略省卫生局行政数据库，结合所有安大略省居民的信息，确定 2008 年 10 月 1 日至 2019 年 9 月 30 日期间因孤立性冠状动脉旁路移植术（CABG）、瓣膜手术、CABG-瓣膜联合手术或胸主动脉手术而转诊的 18 岁或以上患者。我们使用随机森林方法的混合建模方法进行初步变量选择，然后使用向后逐步逻辑回归建模进行临床解释和简化。我们使用 200 次自举法对内逻辑回归模型（称为 CardiOttawa Waitlist Mortality Score）进行了内部验证。
在接受心脏手术转诊的 112266 名患者中，269 名（0.2%）在等待手术期间死亡（118/72366 [0.2%] 孤立性 CABG，81/24461 [0.3%] 瓣膜手术，63/12046 [0.5%] CABG-瓣膜联合手术，7/3393 [0.2%] 胸主动脉手术）。年龄、性别、手术类型、左主干狭窄、加拿大心血管学会分类、左心室射血分数、心力衰竭、心房颤动、透析、精神病和手术优先级是等待名单死亡率的预测因素。该模型具有区分力（C 统计量为 0.76[校正后 0.73]）。它在整个队列中（Hosmer-Lemeshow = 0.2）和各种手术类型中都具有良好的校准效果。
CardiOttawa Waitlist Mortality Score 是一种简单的临床风险模型，可预测等待心脏手术时死亡的可能性。它有可能为管理心脏护理的就诊提供数据驱动的决策支持，并在 COVID-19 大流行、恢复期及以后期间保持系统容量。
