| A Bayesian hierarchical approach to comparative audit for carotid surgery. | |
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MedLine Citation:
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PMID: 12443745 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: the aim of this study was to illustrate how a Bayesian hierarchical modelling approach can aid the reliable comparison of outcome rates between surgeons. DESIGN: retrospective analysis of prospective and retrospective data. MATERIALS: binary outcome data (death/stroke within 30 days), together with information on 15 possible risk factors specific for CEA were available on 836 CEAs performed by four vascular surgeons from 1992-99. The median patient age was 68 (range 38-86) years and 60% were men. METHODS: the model was developed using the WinBUGS software. After adjusting for patient-level risk factors, a cross-validatory approach was adopted to identify "divergent" performance. A ranking exercise was also carried out. RESULTS: the overall observed 30-day stroke/death rate was 3.9% (33/836). The model found diabetes, stroke and heart disease to be significant risk factors. There was no significant difference between the predicted and observed outcome rates for any surgeon (Bayesian p -value>0.05). Each surgeon had a median rank of 3 with associated 95% CI 1.0-5.0, despite the variability of observed stroke/death rate from 2.9-4.4%. After risk adjustment, there was very little residual between-surgeon variability in outcome rate. CONCLUSIONS: Bayesian hierarchical models can help to accurately quantify the uncertainty associated with surgeons' performance and rank. |
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Authors:
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G Kuhan; E C Marshall; A F Abidia; I C Chetter; P T McCollum |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Volume: 24 ISSN: 1078-5884 ISO Abbreviation: Eur J Vasc Endovasc Surg Publication Date: 2002 Dec |
Date Detail:
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Created Date: 2002-11-21 Completed Date: 2003-01-02 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9512728 Medline TA: Eur J Vasc Endovasc Surg Country: England |
Other Details:
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Languages: eng Pagination: 505-10 Citation Subset: IM |
Affiliation:
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Academic Vascular Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Bayes Theorem* Carotid Artery Diseases / complications, mortality, surgery* Clinical Competence / statistics & numerical data* Endarterectomy, Carotid / statistics & numerical data* Female Humans Male Medical Audit / statistics & numerical data* Middle Aged Models, Statistical* Outcome Assessment (Health Care) / statistics & numerical data* Reproducibility of Results Retrospective Studies Survival Rate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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