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Sherlaw-Johnson C, Lovegrove J, Treasure T, et al. Likely variations in perioperative mortality associated with cardiac surgery: when does high mortality reflect bad practice?. Heart. 2000;84(1):79-82doi: 10.1136/heart.84.1.79.
Sherlaw-Johnson, C., Lovegrove, J., Treasure, T., & Gallivan, S. (2000). Likely variations in perioperative mortality associated with cardiac surgery: when does high mortality reflect bad practice?. Heart (British Cardiac Society), 84(1), 79-82. https://doi.org/10.1136/heart.84.1.79
Sherlaw-Johnson, C, et al. "Likely variations in perioperative mortality associated with cardiac surgery: when does high mortality reflect bad practice?." Heart (British Cardiac Society) vol. 84,1 (2000): 79-82. doi: https://doi.org/10.1136/heart.84.1.79
Sherlaw-Johnson C, Lovegrove J, Treasure T, Gallivan S. Likely variations in perioperative mortality associated with cardiac surgery: when does high mortality reflect bad practice?. Heart. 2000 Jul;84(1):79-82. doi: 10.1136/heart.84.1.79. PMID: 10862596; PMCID: PMC1729400.
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Heart. 2000 Jul;84(1):79-82. doi: 10.1136/heart.84.1.79.

Likely variations in perioperative mortality associated with cardiac surgery: when does high mortality reflect bad practice?.

Heart (British Cardiac Society)

C Sherlaw-Johnson, J Lovegrove, T Treasure, S Gallivan

Affiliations

  1. Clinical Operational Research Unit, Department of Mathematics, University College London, 4 Taviton Street, London WC1H 0BT, UK.

PMID: 10862596 PMCID: PMC1729400 DOI: 10.1136/heart.84.1.79

Abstract

OBJECTIVE: Several methods exist for estimating the risk of perioperative mortality based on preoperative risk factors; graphical methods such as the variable life adjusted display (VLAD) can be used to examine how an individual surgeon's performance for a series of operations fares against what would be expected, given the case mix. This study aimed to devise a method for assessing the natural variation in outcome in order to assist with making judgements about individual performance, in particular whether seemingly poor performance could have occurred by chance.

METHOD: The risk scoring system has been derived and validated locally for cardiac surgery. A method is described for calculating the probability that an observed number of deaths occurs within a sequence of operations if perioperative mortality is regarded as a chance event with an expected value derived from the risk score. To illustrate this method, nested prediction intervals are superimposed onto VLAD plots for a series of 393 isolated coronary artery bypass and isolated valve operations performed by a single surgeon.

RESULTS: Using the locally derived risk score, the VLAD plot for the individual surgeon shows a net life gain of about 6 over the predicted number of survivors, which is observed to be within the 90% prediction interval. If the Parsonnet scoring system is used instead of the locally derived risk score, the net life gain is considerably overestimated.

CONCLUSIONS: The nested prediction intervals are straightforward to generate and can be integrated into a visually informative display. As an indication of the inherent variability in outcome, they have a valuable role in the monitoring of surgical performance.

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