CCSIP

Summary of Isolated SAV-Replacement, SMV-Replacement, SMV-Repair with CABG Model based on California Inpatient Discharge Data, 2020-2021

Outcome: MACCE-90 (Multiple Adverse Cardiovascular and Cerebral Events within 90 Days of surgery)

This outcome is determined based on the occurrence of 1 or more of the following events within 90 days of the surgery date:

Death during the surgery admission or during an emergency department encounter or inpatient re-admission within 90 days of the surgery; IP disposition code (prior 2015) '11' or (2015 or later) '20' is used to identify in-hospital deaths; disposition code '20' is used to identify ED deaths.
Post OP Myocardial Infarction (MI) defined as MI during the surgery admission that was not present at admission or an MI during an inpatient re-admission within 90 days of surgery; ICD-9-CM codes used to identify MIs: 410.xx. ICD-10-CM codes used to identify MIs: I21.0x, I21.1x, I21.2x, I21.3, I22.0, I22.1, I22.8, I22.9, I21.4, I22.2.
Post OP Stroke defined as stroke during the surgery admission that was not present at admission or stroke during an inpatient re-admission within 90 days of surgery; ICD-9-CM codes used to identify Strokes: 997.02, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91. ICD-10-CM codes used to identify Strokes: I63.xx, G97.31, G97.32, I97.81x, I97.82x.
Re-Intervention defined as any cardiac surgery / intervention during the index surgery admission that occurred at least 1 day after the index surgery or a cardiac surgery / intervention during an inpatient re-admission within 90 days of surgery The following situations are considered re-interventions: Any procedure in the ICD-9-PCS range 35.xx-38.xx or ICD-10-PCS 02xxxxx that was performed using ECC (ICD-9-PCS code: 39.61, ICD-10-PCS codes: 5A1221Z) or off-pump CABG procedure (ICD-9-PCS: 36.1x, ICD-10-PCS: 0210xxx, 0211xxx, 0212xxx, 0213xxx) or TAVR (ICD-9-PCS: 35.05, 35.06, ICD-10-PCS: 02RF3xx, X2RF3xx). Any PCI (ICD-9-PCS for IP data: 36.01, 36.02, 36.05, 36.06, 36.09, 00.66; ICD-10-PCS for IP data: 02703xx, 02713xx, 02723xx, 02733xx, 02C03xx, 02C13xx, 02C23xx, 02C33xx, X2C03xx, X2C13xx, X2C23xx, X2C33xx, 02704xx, 02714xx, 02724xx, 02734xx, 02C04xx, 02C14xx, 02C24xx, 02C34xx, X2C04xx, X2C14xx, X2C24xx, X2C34xx; CPT codes for ED data for 2012 or earlier: 92980, 92981, 92982, 92983, 92984, 92995, 92996; CPT codes for ED data for 2013: 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944).

All events are weighted equally.
Only patients are included who did not leave against medical advice, who were residents of California at the time of the surgery, and who had surgery prior to 2021-10-02.

Model Statistics:

Number of Observations: 2,855

% of Observations with Outcome: 12.0%

C-statistic: 0.745

Pseudo-R²: 16.4

Hosmer-Lemeshow P-Value: 0.503

Model Details:

Risk Factor		N Cases	% Events	Estimate	Standard Error	Wald Chi²	P-value	Odds Ratio (OR)	Lower 95% CL for OR	Upper 95% CL for OR
Intercept				-1.9	0.3	52.7	0.000
Age at Admission	18-<50	73	17.9	0.3	0.4	0.5	0.467	1.3	0.6	2.8
	50-<55	124	20.8	0.7	0.3	6.1	0.014	2.1	1.2	3.7
	55-<60	213	10.3	-0.3	0.3	0.9	0.335	0.8	0.4	1.3
	60-<65	353	8.9	-0.2	0.3	0.6	0.454	0.8	0.5	1.4
	65-<70	510	11.7				Reference
	70-<75	620	10.5	0.0	0.2	0.1	0.822	1.0	0.7	1.6
	75-<80	547	13.1	0.3	0.2	2.6	0.105	1.4	0.9	2.1
	80 or older	415	13.0	0.4	0.2	3.0	0.083	1.5	1.0	2.3
Patient Sex	Male	2,181	10.6				Reference
	Female	674	16.7	0.4	0.1	7.0	0.008	1.5	1.1	1.9
Patient Race	White	1,749	10.3				Reference
	Non-White	1,106	14.7	0.2	0.1	2.5	0.116	1.2	0.9	1.6
Type of Valve Procedure	SAV-Replacement Only	1,688	9.1				Reference
	SMV-Replacement Only	490	19.2	0.6	0.2	14.4	0.000	1.9	1.4	2.7
	SMV-Repair Only	482	11.6	0.0	0.2	0.0	0.842	1.0	0.7	1.5
	Multiple Valves including SAV-Replacement, SMV-Replacement/Repair	195	20.2	0.7	0.2	10.9	0.001	2.1	1.3	3.3
Underweight / Weight Loss		184	28.6	0.7	0.2	9.9	0.002	1.9	1.3	2.9
Acute MI Present at Unscheduled Admission		583	18.8	0.4	0.2	5.2	0.023	1.4	1.1	1.9
Aortic/Mitral Valve Disease/Stenosis/Insufficiency		2,557	10.4	-1.0	0.2	36.2	0.000	0.4	0.2	0.5
Atrial Fibrillation and Flutter		888	11.3	-0.3	0.1	3.4	0.065	0.8	0.6	1.0
Cardiogenic Shock		105	32.1	0.9	0.3	13.2	0.000	2.6	1.5	4.3
Cardiomyopathy		217	13.5	0.0	0.2	0.0	0.988	1.0	0.6	1.6
Heart Failure		1,581	15.4	0.5	0.1	9.6	0.002	1.6	1.2	2.1
HX Sudden Cardiac Arrest (Begin 2007)		12	10.0	-0.1	1.1	0.0	0.909	0.9	0.1	7.7
Chronic Lung Disease		293	14.2	0.2	0.2	1.2	0.270	1.2	0.8	1.8
Cerebrovascular Disease		279	15.4	0.2	0.2	1.2	0.277	1.2	0.8	1.8
Diabetes		1,281	12.0	-0.2	0.1	2.5	0.111	0.8	0.6	1.1
Infectious Endocarditis		97	21.0	-0.1	0.3	0.1	0.770	0.9	0.5	1.7
Number of Grafts	One	816	11.2	-0.2	0.2	0.9	0.333	0.9	0.6	1.2
	Two	733	11.8	0.0	0.2	0.1	0.813	1.0	0.8	1.4
	Three or More	1,306	12.7				Reference
PCI prior to Admission		324	5.8	-1.0	0.3	12.8	0.000	0.4	0.2	0.6
Prior PCI on same Day as Surgery		8	39.1	1.0	1.0	0.9	0.338	2.6	0.4	18.2
Pre-Op Intra-Aortic Balloon Pump		37	26.6	0.2	0.5	0.2	0.682	1.2	0.5	3.3
Prior CABG/Valve Surgery		134	8.9	-0.3	0.3	0.6	0.441	0.8	0.4	1.5
Peripheral Vascular Disease		499	10.6	-0.2	0.2	0.8	0.363	0.9	0.6	1.2
Renal Failure		894	15.1	0.3	0.1	3.3	0.068	1.3	1.0	1.7
Same Day Tricuspid Valve		179	22.5	0.6	0.2	6.9	0.009	1.8	1.2	2.8
Status of Procedure Urgent		18	22.2	0.6	0.7	0.7	0.393	1.8	0.5	6.5

Notes:

If a patient had more than one surgery event of the same type on different dates during the index admission, only the surgery on the earliest date is included for fitting the model.

CL: Confidence Limit

CABG: Coronary Artery Bypass Graft

PCI: Percutaneous Coronary Intervention

SAV-Replacement: Surgical Aortic Valve Replacement

SMV-Replacement: Surgical Mitral Valve Replacement

SMV-Repair: Surgical Mitral Valve Repair