Development of a Novel Society of Thoracic Surgeons Aortic Surgery Mortality and Morbidity Risk Model.
Publication/Presentation Date
10-2-2024
Abstract
BACKGROUND: The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS-ACSD) was expanded in 2017 to include more granular detail on thoracic aortic surgeries. We describe the first validated risk model in thoracic aortic surgery from the STS-ACSD.
METHODS: The study population consisted of patients undergoing non-emergent isolated ascending aortic aneurysm repair using open or clamped distal anastomoses, including those requiring aortic root or valve replacement. Model outcomes included operative mortality, 30-day major morbidity (cardiac reoperation, deep sternal wound infection, stroke, prolonged ventilation, renal failure) and a composite of both. To select the predictors, univariate associations and clinical face validity of models were examined. Models were evaluated by their ability to distinguish between patients with and without specific outcomes (discrimination) and their predictive accuracy (calibration).
RESULTS: Between 2017 and 2021, 24,051 eligible patients underwent ascending aortic aneurysm surgery at 905 hospitals. Procedures included 8,913 aortic root replacements, 2,135 valve-sparing root replacements, 7,545 ascending aortic replacements with AVR, and 5,458 ascending aortic replacements. Circulatory arrest was performed in 7,316 (30.4%) of cases. Operative mortality was 1.9%, and 12.2% of patients experienced major morbidity including 2.4% incidence of stroke. The adjusted C-statistics for the model were 0.74, 0.67 and 0.67 for mortality, morbidity and the composite, respectively. Previous stroke and circulatory arrest were associated with new stroke. Genetic aortopathy was associated with less mortality.
CONCLUSIONS: A new STS-ACSD risk model to predict mortality and morbidity after ascending aneurysm surgery has been developed, and predictors of better and worse outcomes have been identified.
ISSN
1552-6259
Published In/Presented At
Desai, N. D., Vekstein, A., Grau-Sepulveda, M., O'Brien, S. M., Takayama, H., Chen, E. P., Hughes, G. C., Bavaria, J. E., Shahian, D. M., Ouzounian, M., Roselli, E. E., Jacobs, J. P., Badhwar, V., Habib, R. H., Thourani, V., Bowdish, M. E., & Kim, K. M. (2024). Development of a Novel Society of Thoracic Surgeons Aortic Surgery Mortality and Morbidity Risk Model. The Annals of thoracic surgery, S0003-4975(24)00833-6. Advance online publication. https://doi.org/10.1016/j.athoracsur.2024.09.025
Disciplines
Medicine and Health Sciences
PubMedID
39366649
Department(s)
Department of Surgery
Document Type
Article