Gaming in risk-adjusted mortality rates
Table 1: Center-specific prevalence of risk factors, overall and in outliers All centers
Age (continuous) a 65.9 (63.0-67.2) Female 30.0 (24.8-33.1) Serum creatinine >200 Îźmol/l 2.0 (0.8-3.3) Extracardiac arteriopathy 12.2 (9.0-16.5) Pulmonary disease 11.3 (7.4-17.3) Neurological dysfunction 3.5 (1.1-8.8) Previous cardiac surgery 7.3 (2.5-14.4) Recent myocardial infarct 12.3 (3.4-17.8) LVEF 30â&#x20AC;&#x201C;50% 19.4 (8.2-40.9) LVEF <30% 5.5 (2.7-8.4) Systolic pulmonary pressure 3.2 (1.2-9.3) >60 mmHg Active endocarditis 1.4 (0.7-2.4) Unstable angina 6.2 (2.2-13.8) Emergency operation 6.5 (2.4-10.1) Critical preoperative state 4.7 (2.2-8.7) Ventricular septal rupture 0.2 (0.1-0.5) Other than isolated coronary 45.5 (29.7-62.2) surgery Thoracic aortic surgery 5.4 (1.2-14.4)
Low mortality outliers (A and B) 66.4 30.6 2.0 11.9 13.6 4.8 7.5 12.9 23.2 5.9 2.1
P*
P*
Coefficient in EuroSCORE (13)
<0.01 0.26 0.97 0.42 <0.01 <0.01 0.55 0.13 <0.01 0.12 <0.01
Highmortality outliers (O and P) 65.7 29.7 2.1 13.4 11.0 3.8 9.0 15.1 15.1 5.7 1.9
0.10 0.57 0.40 <0.01 0.35 0.19 <0.01 <0.01 <0.01 0.31 <0.01
0.067 0.330 0.652 0.656 0.493 0.842 1.003 0.546 0.419 1.094 0.768
1.7 5.9 8.3 7.4 0.2 44.4
0.04 0.44 <0.01 <0.01 0.64 0.01
1.4 4.9 6.3 2.8 0.2 45.5
0.89 <0.01 0.46 <0.01 0.63 0.99
1.101 0.568 0.713 0.906 1.462 0.542
3.6
<0.01
5.6
0.33
1.160
Data presented as median, with range in parentheses, unless otherwise noted. EuroSCORE, European system for cardiac operative risk evaluation; LVEF, left ventricular ejection fraction. *P value of difference with other centers. Figure 1: Benchmarking of 16 centers performing cardio-thoracic surgery in The Netherlands
Black diamonds indicate risk of mortality of a patient with the median European system for cardiac operative risk evaluation (EuroSCORE) value (3.9) in each center. Lines indicate corresponding 95% confidence intervals (CIs).
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