CCSIP

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

Outcome: MACCE (Multiple Adverse Cardiovascular and Cerebral Events)

This outcome is determined based on the occurrence of 1 or more of the following events after the index surgery or a subsequent inpatient-readmission connected through the surgery admission via acute transfer:

Death during the surgery admission or during a connected inpatient re-admission; IP disposition code (prior 2015) '11' or (2015 or later) '20' is used to identify in-hospital deaths.
Post OP Myocardial Infarction (MI) defined as MI during the surgery admission that was not present at admission or an MI during a connected inpatient re-admission; ICD-9-CM codes used to identify MIs: 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 a connected inpatient re-admission; 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 a connected acute inpatient re-admission. 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.

Model Statistics:

Number of Observations: 3,271

% of Observations with Outcome: 8.6%

C-statistic: 0.744

Pseudo-R²: 13.6

Hosmer-Lemeshow P-Value: 0.515

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				-2.3	0.3	69.7	0.000
Age at Admission	18-<50	89	13.8	0.3	0.4	0.6	0.433	1.3	0.6	2.8
	50-<55	140	12.4	0.3	0.3	0.7	0.419	1.3	0.7	2.4
	55-<60	244	8.5	-0.2	0.3	0.3	0.579	0.9	0.5	1.5
	60-<65	410	6.7	-0.3	0.3	1.1	0.296	0.8	0.5	1.3
	65-<70	588	8.6				Reference
	70-<75	719	8.0	0.0	0.2	0.0	0.940	1.0	0.7	1.5
	75-<80	624	9.0	0.2	0.2	0.7	0.416	1.2	0.8	1.8
	80 or older	457	8.7	0.2	0.2	0.7	0.407	1.2	0.8	1.9
Patient Sex	Male	2,501	7.6				Reference
	Female	770	11.9	0.3	0.1	3.7	0.053	1.3	1.0	1.8
Patient Race	White	2,010	7.3				Reference
	Non-White	1,261	10.7	0.3	0.1	4.0	0.045	1.3	1.0	1.7
Type of Valve Procedure	SAV-Replacement Only	1,938	6.2				Reference
	SMV-Replacement Only	549	15.1	0.7	0.2	15.9	0.000	2.0	1.4	2.8
	SMV-Repair Only	553	8.1	0.1	0.2	0.1	0.782	1.1	0.7	1.6
	Multiple Valves including SAV-Replacement, SMV-Replacement/Repair	231	14.6	0.8	0.2	11.3	0.001	2.2	1.4	3.4
Underweight / Weight Loss		206	22.2	0.6	0.2	8.0	0.005	1.8	1.2	2.7
Acute MI Present at Unscheduled Admission		662	13.3	0.3	0.2	2.9	0.091	1.3	1.0	1.8
Aortic/Mitral Valve Disease/Stenosis/Insufficiency		2,932	7.2	-1.2	0.2	44.3	0.000	0.3	0.2	0.4
Atrial Fibrillation and Flutter		1,022	8.9	-0.1	0.1	0.3	0.570	0.9	0.7	1.2
Cardiogenic Shock		129	22.2	0.8	0.3	9.5	0.002	2.2	1.3	3.6
Cardiomyopathy		242	9.2	-0.1	0.2	0.2	0.631	0.9	0.5	1.4
Heart Failure		1,795	11.3	0.5	0.2	8.8	0.003	1.6	1.2	2.1
HX Sudden Cardiac Arrest (Begin 2007)		15	6.7	-0.5	1.1	0.2	0.680	0.6	0.1	5.5
Chronic Lung Disease		334	10.9	0.3	0.2	1.9	0.172	1.3	0.9	2.0
Cerebrovascular Disease		312	10.7	0.1	0.2	0.1	0.747	1.1	0.7	1.6
Diabetes		1,458	8.6	-0.2	0.1	1.6	0.203	0.8	0.6	1.1
Infectious Endocarditis		115	18.7	0.2	0.3	0.4	0.551	1.2	0.7	2.2
Number of Grafts	One	949	8.0	-0.1	0.2	0.4	0.545	0.9	0.6	1.3
	Two	842	9.5	0.2	0.2	2.0	0.153	1.3	0.9	1.7
	Three or More	1,480	8.5				Reference
PCI prior to Admission		368	4.7	-0.7	0.3	6.5	0.011	0.5	0.3	0.9
Prior PCI on same Day as Surgery		10	20.0	-0.3	1.0	0.1	0.761	0.7	0.1	5.4
Pre-Op Intra-Aortic Balloon Pump		42	19.0	0.5	0.5	1.1	0.296	1.7	0.6	4.3
Prior CABG/Valve Surgery		154	5.5	-0.5	0.4	2.0	0.153	0.6	0.3	1.2
Peripheral Vascular Disease		581	7.2	-0.2	0.2	1.3	0.253	0.8	0.6	1.2
Renal Failure		1,015	10.7	0.2	0.1	1.6	0.207	1.2	0.9	1.6
Same Day Tricuspid Valve		206	15.0	0.4	0.2	2.6	0.105	1.5	0.9	2.3
Status of Procedure Urgent		22	18.2	0.7	0.7	1.0	0.314	2.0	0.5	7.2

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