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Predicting the Occurrence of Adverse Events after Coronary Artery Bypass Surgery

Jane M. Geraci, MD, MPH; Amy K. Rosen, PhD; Arlene S. Ash, PhD; Kathleen J. McNiff, MPH; and Mark A. Moskowitz, MD
[+] Article and Author Information

From Boston University Medical Center and Boston University School of Public Health, Boston, Massachusetts. Requests for Reprints: Mark A. Moskowitz, MD, Section General Internal Medicine, Boston University Medical Center, Suite 1108, 720 Harrison Avenue, Boston, MA 02118. Acknowledgments: The authors thank Leanne Gitell and Gerald Coffman for assistance manuscript preparation. Grant Support: By the Health Care Financing Administration under cooperative agreement no. 99-C-98526/1-06.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1993;118(1):18-24. doi:10.7326/0003-4819-118-1-199301010-00004
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Objective: To determine whether adverse events occurring after coronary artery bypass surgery in Medicare patients can be predicted from clinical variables representing illness severity at admission.

Design: Retrospective analysis of clinical data abstracted from hospital charts, with development and validation using half-samples of the database. A logistic model was developed using illness severity at admission to predict the occurrence of an adverse event after bypass surgery.

Setting: Hospitals in seven states.

Patients: Random sample of 2213 Medicare patients 65 years of age or more who underwent bypass surgery between January 1985 and June 1986.

Outcome Measure: The occurrence of death within 30 days of admission or any of 13 nonfatal postoperative adverse events (for example, myocardial infarction, congestive heart failure, and wound infection).

Results: Thirty-three percent of patients had one or more postoperative adverse events or died within 30 days of admission. Mortality within 30 days of admission was 6.6%; each adverse event was associated with increased mortality (range, 7.5% to 66.7%). Admission predictors of the occurrence of an adverse event included a history of bypass surgery, emergent surgery, a history of chronic obstructive pulmonary disease, the presence of an infiltrate on admission chest radiograph, a pulse of 110 beats/min or more, age, blood urea nitrogen of 10.7 mmol/L (30 mg/dL) or more, acute myocardial infarction at admission, and a history of myocardial infarction; the presence of one-or two-vessel disease was negatively associated with the occurrence of an adverse event. The model c-statistic was 0.64.

Conclusions: Severity of illness at admission has modest predictive power with respect to adverse-event occurrence in Medicare patients who undergo bypass surgery.

Figures

Grahic Jump Location
Figure 1.
Receiver-operating-characteristic curve for predicting any severe adverse event after coronary artery bypass graft surgery.
Grahic Jump Location

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