Document Detail

A Bayesian hierarchical approach to comparative audit for carotid surgery.
MedLine Citation:
PMID:  12443745     Owner:  NLM     Status:  MEDLINE    
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.
G Kuhan; E C Marshall; A F Abidia; I C Chetter; P T McCollum
Related Documents :
11888955 - Prospective testing of two models based on clinical and oximetric variables for predict...
24927945 - Slope estimation and viewing distance of the observer.
24052685 - Statistical methods for estimation of direct and differential kinematics of the vocal t...
24505715 - Surface smoothing: a way back in early brain morphogenesis.
20304725 - Fast semi-analytical model-based acoustic inversion for quantitative optoacoustic tomog...
22938205 - Comparison of response rates and cost-effectiveness for a community-based survey: posta...
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  2002-11-21     Completed Date:  2003-01-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  505-10     Citation Subset:  IM    
Academic Vascular Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aged, 80 and over
Bayes Theorem*
Carotid Artery Diseases / complications,  mortality,  surgery*
Clinical Competence / statistics & numerical data*
Endarterectomy, Carotid / statistics & numerical data*
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

Previous Document:  Ultrasonic analysis of plaque characteristics and intimal-medial thickness in radiation-induced athe...
Next Document:  Results of a European multicentre iliac stent trial with a flexible balloon expandable stent.