title: The Abdominal Aortic Aneurysm Statistically Corrected Operative Risk Evaluation (AAA SCORE) for predicting mortality after open and endovascular interventions.
abstract: BACKGROUND
  Accurate adjustment of surgical outcome data for risk is vital in an era of surgeon-level reporting. Current risk prediction models for abdominal aortic aneurysm (AAA) repair are suboptimal. We aimed to develop a reliable risk model for in-hospital mortality after intervention for AAA, using rigorous contemporary statistical techniques to handle missing data.
  
  
  METHODS
  Using data collected during a 15-month period in the United Kingdom National Vascular Database, we applied multiple imputation methodology together with stepwise model selection to generate preoperative and perioperative models of in-hospital mortality after AAA repair, using two thirds of the available data. Model performance was then assessed on the remaining third of the data by receiver operating characteristic curve analysis and compared with existing risk prediction models. Model calibration was assessed by Hosmer-Lemeshow analysis.
  
  
  RESULTS
  A total of 8088 AAA repair operations were recorded in the National Vascular Database during the study period, of which 5870 (72.6%) were elective procedures. Both preoperative and perioperative models showed excellent discrimination, with areas under the receiver operating characteristic curve of .89 and .92, respectively. This was significantly better than any of the existing models (area under the receiver operating characteristic curve for best comparator model, .84 and .88; P < .001 and P = .001, respectively). Discrimination remained excellent when only elective procedures were considered. There was no evidence of miscalibration by Hosmer-Lemeshow analysis.
  
  
  CONCLUSIONS
  We have developed accurate models to assess risk of in-hospital mortality after AAA repair. These models were carefully developed with rigorous statistical methodology and significantly outperform existing methods for both elective cases and overall AAA mortality. These models will be invaluable for both preoperative patient counseling and accurate risk adjustment of published outcome data.
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. Electronic address: graeme.ambler@gmail.com.
authors.forename: Graeme K
authors.initials: GK
authors.lastname: Ambler
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Gohel
authors.affiliation: Department of Surgery, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom.
authors.forename: David C
authors.initials: DC
authors.lastname: Mitchell
authors.affiliation: St George's Vascular Institute, St George's, University of London, London, United Kingdom.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Loftus
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Boyle
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019540:Area Under Curve; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D016208:Databases, Factual; D003661:Decision Support Techniques; D016002:Discriminant Analysis; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States