Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

Niki Lijftogt, Esmee M. van der Willik, Michel W. J. M. Wouters, In collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing, R. Balm, M. van den Berg, J. D. Blankensteijn, J. Bosma, J. L. de Bruin, M. G. Buimer, E. Cancrinus, G. Cazander, H. M. Coveliers, J. Diks, R. C. van Doorn, A. van der Elst, A. W. Hoksbergen, L. C. Huisman, M. M. Idu, M. J. Jacobs & 33 others J. R. Jansbeken, V. Jongkind, M. J. Koelemaij, D. A. Legemate, M. M. Lensvelt, M. J. Loos, E. C. Mattens, C. C. Naves, J. H. Nederhoed, D. H. Nieuwenhuis, A. Rijbroek, M. P. Siroen, D. A. Stigter, W. J. Thijsse, M. Truijers, H. J. Verhagen, C. F. Vermeulen, E. G. Vermeulen, M. J. Visser, C. J. Vlijmen - van Keulen, A. W. Vos, B. de Vos, A. C. de Vries, J. P. de Vries, M. de Vries, A. M. Wiersema, M. C. Willems, W. Wisselink, M. E. Witte, C. H. Wittens, M. L. van Zeeland, Anco C. Vahl, Vanessa J. Leijdekkers

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model. Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05. Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively. Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.
Original languageEnglish
Pages (from-to)103-111
JournalAnnals of Vascular Surgery
Volume60
DOIs
Publication statusPublished - 1 Oct 2019

Cite this

Lijftogt, N., van der Willik, E. M., Wouters, M. W. J. M., In collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing, Balm, R., van den Berg, M., ... Leijdekkers, V. J. (2019). Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit. Annals of Vascular Surgery, 60, 103-111. https://doi.org/10.1016/j.avsg.2019.02.032
Lijftogt, Niki ; van der Willik, Esmee M. ; Wouters, Michel W. J. M. ; In collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing ; Balm, R. ; van den Berg, M. ; Blankensteijn, J. D. ; Bosma, J. ; de Bruin, J. L. ; Buimer, M. G. ; Cancrinus, E. ; Cazander, G. ; Coveliers, H. M. ; Diks, J. ; van Doorn, R. C. ; van der Elst, A. ; Hoksbergen, A. W. ; Huisman, L. C. ; Idu, M. M. ; Jacobs, M. J. ; Jansbeken, J. R. ; Jongkind, V. ; Koelemaij, M. J. ; Legemate, D. A. ; Lensvelt, M. M. ; Loos, M. J. ; Mattens, E. C. ; Naves, C. C. ; Nederhoed, J. H. ; Nieuwenhuis, D. H. ; Rijbroek, A. ; Siroen, M. P. ; Stigter, D. A. ; Thijsse, W. J. ; Truijers, M. ; Verhagen, H. J. ; Vermeulen, C. F. ; Vermeulen, E. G. ; Visser, M. J. ; Vlijmen - van Keulen, C. J. ; Vos, A. W. ; de Vos, B. ; de Vries, A. C. ; de Vries, J. P. ; de Vries, M. ; Wiersema, A. M. ; Willems, M. C. ; Wisselink, W. ; Witte, M. E. ; Wittens, C. H. ; van Zeeland, M. L. ; Vahl, Anco C. ; Leijdekkers, Vanessa J. / Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit. In: Annals of Vascular Surgery. 2019 ; Vol. 60. pp. 103-111.
@article{4d4bd4d5de374a3b8cf8a9b8ae08ccc6,
title = "Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit",
abstract = "Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model. Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05. Results: There were 12,401 patients: 9,537 (76.9{\%}) elective patients (EAAA), 913 (7.4{\%}) acute symptomatic patients (SAAA), and 1,951 (15.7{\%}) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5{\%}; 1.8{\%} after EAAA surgery, 6.6{\%} after SAAA, and 29.6{\%} after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively. Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.",
author = "Niki Lijftogt and {van der Willik}, {Esmee M.} and Wouters, {Michel W. J. M.} and {In collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing} and R. Balm and {van den Berg}, M. and Blankensteijn, {J. D.} and J. Bosma and {de Bruin}, {J. L.} and Buimer, {M. G.} and E. Cancrinus and G. Cazander and Coveliers, {H. M.} and J. Diks and {van Doorn}, {R. C.} and {van der Elst}, A. and Hoksbergen, {A. W.} and Huisman, {L. C.} and Idu, {M. M.} and Jacobs, {M. J.} and Jansbeken, {J. R.} and V. Jongkind and Koelemaij, {M. J.} and Legemate, {D. A.} and Lensvelt, {M. M.} and Loos, {M. J.} and Mattens, {E. C.} and Naves, {C. C.} and Nederhoed, {J. H.} and Nieuwenhuis, {D. H.} and A. Rijbroek and Siroen, {M. P.} and Stigter, {D. A.} and Thijsse, {W. J.} and M. Truijers and Verhagen, {H. J.} and Vermeulen, {C. F.} and Vermeulen, {E. G.} and Visser, {M. J.} and {Vlijmen - van Keulen}, {C. J.} and Vos, {A. W.} and {de Vos}, B. and {de Vries}, {A. C.} and {de Vries}, {J. P.} and {de Vries}, M. and Wiersema, {A. M.} and Willems, {M. C.} and W. Wisselink and Witte, {M. E.} and Wittens, {C. H.} and {van Zeeland}, {M. L.} and Vahl, {Anco C.} and Leijdekkers, {Vanessa J.}",
year = "2019",
month = "10",
day = "1",
doi = "10.1016/j.avsg.2019.02.032",
language = "English",
volume = "60",
pages = "103--111",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",

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Lijftogt, N, van der Willik, EM, Wouters, MWJM, In collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing, Balm, R, van den Berg, M, Blankensteijn, JD, Bosma, J, de Bruin, JL, Buimer, MG, Cancrinus, E, Cazander, G, Coveliers, HM, Diks, J, van Doorn, RC, van der Elst, A, Hoksbergen, AW, Huisman, LC, Idu, MM, Jacobs, MJ, Jansbeken, JR, Jongkind, V, Koelemaij, MJ, Legemate, DA, Lensvelt, MM, Loos, MJ, Mattens, EC, Naves, CC, Nederhoed, JH, Nieuwenhuis, DH, Rijbroek, A, Siroen, MP, Stigter, DA, Thijsse, WJ, Truijers, M, Verhagen, HJ, Vermeulen, CF, Vermeulen, EG, Visser, MJ, Vlijmen - van Keulen, CJ, Vos, AW, de Vos, B, de Vries, AC, de Vries, JP, de Vries, M, Wiersema, AM, Willems, MC, Wisselink, W, Witte, ME, Wittens, CH, van Zeeland, ML, Vahl, AC & Leijdekkers, VJ 2019, 'Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit' Annals of Vascular Surgery, vol. 60, pp. 103-111. https://doi.org/10.1016/j.avsg.2019.02.032

Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit. / Lijftogt, Niki; van der Willik, Esmee M.; Wouters, Michel W. J. M.; In collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing ; Balm, R.; van den Berg, M.; Blankensteijn, J. D.; Bosma, J.; de Bruin, J. L.; Buimer, M. G.; Cancrinus, E.; Cazander, G.; Coveliers, H. M.; Diks, J.; van Doorn, R. C.; van der Elst, A.; Hoksbergen, A. W.; Huisman, L. C.; Idu, M. M.; Jacobs, M. J.; Jansbeken, J. R.; Jongkind, V.; Koelemaij, M. J.; Legemate, D. A.; Lensvelt, M. M.; Loos, M. J.; Mattens, E. C.; Naves, C. C.; Nederhoed, J. H.; Nieuwenhuis, D. H.; Rijbroek, A.; Siroen, M. P.; Stigter, D. A.; Thijsse, W. J.; Truijers, M.; Verhagen, H. J.; Vermeulen, C. F.; Vermeulen, E. G.; Visser, M. J.; Vlijmen - van Keulen, C. J.; Vos, A. W.; de Vos, B.; de Vries, A. C.; de Vries, J. P.; de Vries, M.; Wiersema, A. M.; Willems, M. C.; Wisselink, W.; Witte, M. E.; Wittens, C. H.; van Zeeland, M. L.; Vahl, Anco C.; Leijdekkers, Vanessa J.

In: Annals of Vascular Surgery, Vol. 60, 01.10.2019, p. 103-111.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

AU - Lijftogt, Niki

AU - van der Willik, Esmee M.

AU - Wouters, Michel W. J. M.

AU - In collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing

AU - Balm, R.

AU - van den Berg, M.

AU - Blankensteijn, J. D.

AU - Bosma, J.

AU - de Bruin, J. L.

AU - Buimer, M. G.

AU - Cancrinus, E.

AU - Cazander, G.

AU - Coveliers, H. M.

AU - Diks, J.

AU - van Doorn, R. C.

AU - van der Elst, A.

AU - Hoksbergen, A. W.

AU - Huisman, L. C.

AU - Idu, M. M.

AU - Jacobs, M. J.

AU - Jansbeken, J. R.

AU - Jongkind, V.

AU - Koelemaij, M. J.

AU - Legemate, D. A.

AU - Lensvelt, M. M.

AU - Loos, M. J.

AU - Mattens, E. C.

AU - Naves, C. C.

AU - Nederhoed, J. H.

AU - Nieuwenhuis, D. H.

AU - Rijbroek, A.

AU - Siroen, M. P.

AU - Stigter, D. A.

AU - Thijsse, W. J.

AU - Truijers, M.

AU - Verhagen, H. J.

AU - Vermeulen, C. F.

AU - Vermeulen, E. G.

AU - Visser, M. J.

AU - Vlijmen - van Keulen, C. J.

AU - Vos, A. W.

AU - de Vos, B.

AU - de Vries, A. C.

AU - de Vries, J. P.

AU - de Vries, M.

AU - Wiersema, A. M.

AU - Willems, M. C.

AU - Wisselink, W.

AU - Witte, M. E.

AU - Wittens, C. H.

AU - van Zeeland, M. L.

AU - Vahl, Anco C.

AU - Leijdekkers, Vanessa J.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model. Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05. Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively. Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

AB - Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model. Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05. Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively. Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85066838227&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31075453

U2 - 10.1016/j.avsg.2019.02.032

DO - 10.1016/j.avsg.2019.02.032

M3 - Article

VL - 60

SP - 103

EP - 111

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

ER -

Lijftogt N, van der Willik EM, Wouters MWJM, In collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing, Balm R, van den Berg M et al. Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit. Annals of Vascular Surgery. 2019 Oct 1;60:103-111. https://doi.org/10.1016/j.avsg.2019.02.032