Summary of TAVR 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).
Model Statistics:
Number of Observations: 15,380
% of Observations with Outcome: 2.6%
C-statistic: 0.699
Pseudo-R2: 7.2
Hosmer-Lemeshow P-Value: 0.438
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 | -4.3 | 0.3 | 195.0 | 0.000 | ||||||
| Age at Admission | 18-<60 | 423 | 3.1 | 0.0 | 0.3 | 0.0 | 0.989 | 1.0 | 0.5 | 1.9 |
| 60-<65 | 524 | 3.2 | 0.2 | 0.3 | 0.6 | 0.431 | 1.2 | 0.7 | 2.2 | |
| 65-<70 | 1,274 | 2.1 | -0.3 | 0.2 | 1.3 | 0.261 | 0.8 | 0.5 | 1.2 | |
| 70-<75 | 2,392 | 1.8 | -0.4 | 0.2 | 4.1 | 0.042 | 0.7 | 0.5 | 1.0 | |
| 75-<80 | 3,031 | 2.4 | -0.1 | 0.2 | 0.5 | 0.480 | 0.9 | 0.6 | 1.2 | |
| 80-<85 | 3,329 | 2.7 | 0.0 | 0.2 | 0.0 | 0.893 | 1.0 | 0.7 | 1.3 | |
| 85-<90 | 2,729 | 3.0 | Reference | |||||||
| 90-<95 | 1,381 | 3.2 | 0.0 | 0.2 | 0.0 | 0.929 | 1.0 | 0.7 | 1.5 | |
| 95 or older | 297 | 3.0 | -0.1 | 0.4 | 0.1 | 0.760 | 0.9 | 0.4 | 1.8 | |
| Patient Sex | Male | 8,951 | 2.2 | Reference | ||||||
| Female | 6,429 | 3.1 | 0.4 | 0.1 | 12.7 | 0.000 | 1.5 | 1.2 | 1.8 | |
| Patient Race | White | 11,131 | 2.4 | Reference | ||||||
| Non-White | 4,249 | 3.1 | 0.2 | 0.1 | 2.6 | 0.105 | 1.2 | 1.0 | 1.5 | |
| Underweight / Weight Loss | 397 | 12.4 | 1.5 | 0.2 | 72.7 | 0.000 | 4.4 | 3.1 | 6.1 | |
| Acute MI Present at Unscheduled Admission | 274 | 9.6 | 0.9 | 0.2 | 16.5 | 0.000 | 2.6 | 1.6 | 4.0 | |
| Aortic/Mitral Valve Disease/Stenosis/Insufficiency | 14,741 | 2.6 | -0.2 | 0.2 | 1.0 | 0.330 | 0.8 | 0.5 | 1.3 | |
| Atrial Fibrillation and Flutter | 5,191 | 3.2 | 0.3 | 0.1 | 5.6 | 0.018 | 1.3 | 1.0 | 1.6 | |
| Cardiogenic Shock | 145 | 15.3 | 1.4 | 0.3 | 27.9 | 0.000 | 4.0 | 2.4 | 6.7 | |
| Cardiomyopathy | 894 | 3.4 | 0.1 | 0.2 | 0.3 | 0.580 | 1.1 | 0.8 | 1.7 | |
| Coronary Artery Disease | 9,261 | 2.7 | 0.1 | 0.1 | 0.6 | 0.452 | 1.1 | 0.9 | 1.4 | |
| Heart Failure | 10,254 | 3.0 | 0.3 | 0.1 | 3.9 | 0.047 | 1.3 | 1.0 | 1.7 | |
| Chronic Lung Disease | 1,975 | 2.2 | -0.2 | 0.2 | 2.2 | 0.135 | 0.8 | 0.6 | 1.1 | |
| Cerebrovascular Disease | 1,100 | 5.5 | 0.8 | 0.1 | 30.8 | 0.000 | 2.3 | 1.7 | 3.1 | |
| Diabetes | 5,529 | 2.7 | 0.0 | 0.1 | 0.0 | 0.993 | 1.0 | 0.8 | 1.3 | |
| Pre-Op Intra-Aortic Balloon Pump | 2,837 | 3.2 | 0.2 | 0.1 | 3.7 | 0.055 | 1.3 | 1.0 | 1.6 | |
| Prior CABG/Valve Surgery | 1,933 | 1.9 | -0.3 | 0.2 | 3.4 | 0.064 | 0.7 | 0.5 | 1.0 | |
| Peripheral Vascular Disease | 2,965 | 3.5 | 0.3 | 0.1 | 7.6 | 0.006 | 1.4 | 1.1 | 1.8 | |
| Renal Failure | 5,242 | 3.3 | 0.2 | 0.1 | 3.9 | 0.048 | 1.2 | 1.0 | 1.5 | |
| Status of Procedure Urgent | 100 | 8.0 | 1.2 | 0.4 | 9.2 | 0.002 | 3.2 | 1.5 | 6.8 | |
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
TAVR: Transcatheter Aortic Valve Replacement