Validation of three models predicting in-hospital death in patients with an abdominal aortic aneurysm eligible for both endovascular and open repair

Objective The Medicare, the Vascular Governance North West (VGNW), and the British Aneurysm Repair (BAR) models can be used to predict in-hospital death after an intervention for an asymptomatic abdominal aortic aneurysm (AAA). Validation of these models in patients with suitable aortic anatomy for...

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Bibliographic Details
Published in:Journal of vascular surgery 2013-12, Vol.58 (6), p.1452-1457.e1
Main Authors: van Beek, Sytse C., MD, Blankensteijn, Jan D., MD, PhD, Balm, Ron, MD, PhD
Format: Article
Language:English
Subjects:
Aged
Aortic Aneurysm, Abdominal - mortality
Aortic Aneurysm, Abdominal - surgery
Belgium - epidemiology
Elective Surgical Procedures - methods
Endovascular Procedures
Female
Forecasting
Hospital Mortality - trends
Humans
Male
Netherlands - epidemiology
Reproducibility of Results
Risk Assessment - methods
Risk Factors
Surgery
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Summary:Objective The Medicare, the Vascular Governance North West (VGNW), and the British Aneurysm Repair (BAR) models can be used to predict in-hospital death after an intervention for an asymptomatic abdominal aortic aneurysm (AAA). Validation of these models in patients with suitable aortic anatomy for endovascular repair and a general condition fit for open repair is lacking. We validated the Medicare, VGNW, and BAR models in patients from a randomized controlled trial comparing open and endovascular AAA repair. Methods A per-protocol analysis was done of 345 Dutch and Belgian patients with in-hospital death as the primary end point. The prediction models were validated taking into account discrimination (the ability to distinguish between death and survival) and calibration (the agreement between predicted and observed death rates). Discrimination was assessed using the area under the receiver-operating characteristics curve (AUC). An AUC >0.70 was considered to be sufficiently accurate. Calibration was assessed using the Hosmer-Lemeshow (HL) test, and P > .05 was considered to be sufficiently accurate. Results The AUC was 0.77 (95% confidence interval [CI], 0.64-0.90; HL test, P  = .52) for the Medicare model, 0.88 (95% CI, 0.81-0.95; HL test, P  = .31) for the VGNW model, and 0.79 (95% CI, 0.67-0.91; HL test, P  = .15) for the BAR model. Conclusions In AAA patients eligible for endovascular and open repair, the predictions of in-hospital death by the Medicare, VGNW, and BAR models were sufficiently accurate. Therefore, these models can be used to support deciding between endovascular and open repair.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2013.05.104