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Acute Physiology and Chronic Health Evaluation (APACHE) III outcome prediction after major vascular surgery.
J Cardiothorac Vasc Anesth. 2008 Oct; 22(5):713-8.JC

Abstract

OBJECTIVE

To investigate the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) III scoring system in patients admitted to the intensive care unit (ICU) after major vascular surgery.

DESIGN

Retrospective cohort study.

SETTING

A tertiary referral center.

PARTICIPANTS

Three thousand one hundred forty-eight patients who underwent major vascular surgery between October 1994 and March 2006.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Data were abstracted from an institutional APACHE III database. Standardized mortality ratios (SMRs) (with 95% confidence intervals) were calculated. The area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow C statistic were used to assess discrimination and calibration, respectively. The mean age of 3,148 patients studied was 70.5 years (+/- standard deviation 9.6). The mean Acute Physiology Score and the APACHE III score on the day of ICU admission were 31.0 (+/- 17.5) and 45.1 (+/- 18.8), respectively. The mean predicted ICU and hospital mortality rates were 3.2% (+/- 7.8%) and 5.0% (+/- 9.5%), respectively. The median (and interquartile range) ICU and hospital lengths of stay were 4.3 (3.6-5.1) and 14 days (11.9-16.8 days), respectively. The observed ICU mortality rate was 2.4% (75/3, 148 patients) and hospital mortality rate was 3.7% (116/3,148). The ICU and hospital SMRs were 0.74 (0.58-0.91) and 0.74 (0.61-0.88), respectively. The AUC of APACHE III-derived prediction of hospital mortality was 0.840 (95% confidence interval, 0.799-0.880), indicating excellent discrimination. The Hosmer-Lemeshow C statistic was 28.492, with a p value <0.01, indicating poor calibration.

CONCLUSIONS

The APACHE III scoring system discriminates well between survivors and nonsurvivors after major vascular surgery, but calibration of the model is poor.

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Authors+Show Affiliations

Keegan MT
Department of Anesthesiology, Division of Critical Care, Mayo Clinic, Rochester, MN 55905, USA. keegan.mark@mayo.edu
Whalen FX
No affiliation info available
Brown DR
No affiliation info available
Roy TK
No affiliation info available
Afessa B
No affiliation info available

MeSH

APACHEAgedAortic Aneurysm, AbdominalArea Under CurveCohort StudiesFemaleHospital MortalityHumansIntensive Care UnitsMaleMiddle AgedRetrospective StudiesTreatment OutcomeVascular Surgical Procedures

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18922428

Citation

Keegan, Mark T., et al. "Acute Physiology and Chronic Health Evaluation (APACHE) III Outcome Prediction After Major Vascular Surgery." Journal of Cardiothoracic and Vascular Anesthesia, vol. 22, no. 5, 2008, pp. 713-8.
Keegan MT, Whalen FX, Brown DR, et al. Acute Physiology and Chronic Health Evaluation (APACHE) III outcome prediction after major vascular surgery. J Cardiothorac Vasc Anesth. 2008;22(5):713-8.
Keegan, M. T., Whalen, F. X., Brown, D. R., Roy, T. K., & Afessa, B. (2008). Acute Physiology and Chronic Health Evaluation (APACHE) III outcome prediction after major vascular surgery. Journal of Cardiothoracic and Vascular Anesthesia, 22(5), 713-8. https://doi.org/10.1053/j.jvca.2008.01.009
Keegan MT, et al. Acute Physiology and Chronic Health Evaluation (APACHE) III Outcome Prediction After Major Vascular Surgery. J Cardiothorac Vasc Anesth. 2008;22(5):713-8. PubMed PMID: 18922428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Physiology and Chronic Health Evaluation (APACHE) III outcome prediction after major vascular surgery. AU - Keegan,Mark T, AU - Whalen,Francis X, AU - Brown,Daniel R, AU - Roy,Tuhin K, AU - Afessa,Bekele, Y1 - 2008/03/28/ PY - 2007/09/01/received PY - 2008/10/17/pubmed PY - 2009/1/28/medline PY - 2008/10/17/entrez SP - 713 EP - 8 JF - Journal of cardiothoracic and vascular anesthesia JO - J Cardiothorac Vasc Anesth VL - 22 IS - 5 N2 - OBJECTIVE: To investigate the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) III scoring system in patients admitted to the intensive care unit (ICU) after major vascular surgery. DESIGN: Retrospective cohort study. SETTING: A tertiary referral center. PARTICIPANTS: Three thousand one hundred forty-eight patients who underwent major vascular surgery between October 1994 and March 2006. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were abstracted from an institutional APACHE III database. Standardized mortality ratios (SMRs) (with 95% confidence intervals) were calculated. The area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow C statistic were used to assess discrimination and calibration, respectively. The mean age of 3,148 patients studied was 70.5 years (+/- standard deviation 9.6). The mean Acute Physiology Score and the APACHE III score on the day of ICU admission were 31.0 (+/- 17.5) and 45.1 (+/- 18.8), respectively. The mean predicted ICU and hospital mortality rates were 3.2% (+/- 7.8%) and 5.0% (+/- 9.5%), respectively. The median (and interquartile range) ICU and hospital lengths of stay were 4.3 (3.6-5.1) and 14 days (11.9-16.8 days), respectively. The observed ICU mortality rate was 2.4% (75/3, 148 patients) and hospital mortality rate was 3.7% (116/3,148). The ICU and hospital SMRs were 0.74 (0.58-0.91) and 0.74 (0.61-0.88), respectively. The AUC of APACHE III-derived prediction of hospital mortality was 0.840 (95% confidence interval, 0.799-0.880), indicating excellent discrimination. The Hosmer-Lemeshow C statistic was 28.492, with a p value <0.01, indicating poor calibration. CONCLUSIONS: The APACHE III scoring system discriminates well between survivors and nonsurvivors after major vascular surgery, but calibration of the model is poor. SN - 1532-8422 UR - https://www.unboundmedicine.com/medline/citation/18922428/Acute_Physiology_and_Chronic_Health_Evaluation__APACHE__III_outcome_prediction_after_major_vascular_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(08)00010-4 DB - PRIME DP - Unbound Medicine ER -