Development and validation of a clinical prediction rule for major adverse outcomes in coronary bypass grafting∗
Section snippets
Patient population:
Data collection took place at 12 medical centers. All 12 were large tertiary care centers and were members of the Academic Medical Center Consortium, which sponsored the study called the Quality Measurement and Management Initiative (QMMI) Coronary Revascularization Project. Patient enrollment took place from August 1993 to October 1995. Patients enrolled in the study included all patients who underwent a CABG procedure not involving valvular or other surgeries at any of the 12 participating
Results
The QMMI dataset included 9,498 patients who underwent CABG not involving valvular or other concomitant procedures, with 6,237 patients allocated at random to the derivation set and the remaining 3,261 to the validation set (Table 1). Differences in preoperative patient characteristics were not significant across groups. One or more major adverse outcomes were found to occur in 6.5% of patients in the derivation subset. A total of 408 patients had a major adverse event. Of these, there were 157
Discussion
In this study, we developed and internally validated a clinical prediction rule that estimated the risk of major adverse outcomes after CABG surgery in a large cohort of patients from 12 large, geographically dispersed academic medical centers. Given the increasing availability of information on patient outcomes from different clinical settings, a severity model such as this has the potential to fill certain important roles, such as facilitating more accurate comparisons of outcomes across
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