External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery

Lucia Cocomello; Massimo Caputo; Rosie Cornish; Deborah Lawlor

doi:10.1136/bmjopen-2020-039236

External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery

BMJ Open. 2020 Nov 27;10(11):e039236. doi: 10.1136/bmjopen-2020-039236.

Authors

Lucia Cocomello¹, Massimo Caputo², Rosie Cornish³, Deborah Lawlor⁴

Affiliations

¹ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK nn18747@bristol.ac.uk.
² Bristol Heart Institute, University of Bristol, Bristol, UK.
³ Population Health Science, Bristol Medical School University of Bristol, Bristol, United Kingdom.
⁴ MRC Integrative Epidemiology Unit, Department of Social Medicine, University of Bristol, Bristol, UK.

Abstract

Objective: Independent temporal external validation of the improving partial risk adjustment in surgery model (PRAIS-2) to predict 30-day mortality in patients undergoing paediatric cardiac surgery.

Design: Retrospective analysis of prospectively collected data.

Setting: Paediatric cardiac surgery.

Intervention: PRAIS-2 validation was carried out using a two temporally different single centre (Bristol, UK) cohorts: Cohort 1 surgery undertaken from April 2004 to March 2009 and Cohort 2 from April 2015 to July 2019. For each subject PRAIS-2 score was calculated according to the original formula.

Participants: A total of 1352 (2004-2009) and 1197 (2015-2019) paediatric cardiac surgical procedures were included in the Cohort 1 and Cohort 2, respectively (median age at the procedure 6.3 and 7.1 months).

Primary and secondary outcome measures: PRAIS-2 performance was assessed in terms of discrimination by means of ROC (receiver operating characteristic) curve analysis and calibration by using the calibration belt method.

Results: PRAIS-2 score showed excellent discrimination for both cohorts (AUC 0.72 (95%CI: 0.65 to 0.80) and 0.88 (95%CI: 0.82 to 0.93), respectively). While PRAIS-2 was only marginally calibrated in Cohort 1, with a tendency to underestimate risk in lowrisk and overestimate risk in high risk procedures (P-value = 0.033), validation in Cohort 2 showed good calibration with the 95% confidence belt containing the bisector for predicted mortality (P-value = 0.143). We also observed good prediction accuracy in the non-elective procedures (N = 483;AUC 0.78 (95%CI 0.68 to 0.87); Calibration belt containing the bisector (P-value=0.589).

Conclusions: In a single centre UK-based cohort, PRAIS-2 showed excellent discrimination and calibration in predicting 30-day mortality in paediatric cardiac surgery including in those undergoing non-elective procedures. Our results support a wider adoption of PRAIS-2 score in the clinical practice.

Keywords: cardiothoracic surgery; congenital heart disease; paediatric cardiac surgery; paediatric cardiology; paediatric cardiothoracic surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiac Surgical Procedures*
Child
Hospital Mortality
Humans
ROC Curve
Retrospective Studies
Risk Adjustment*
Risk Assessment
Risk Factors

Abstract

Publication types

MeSH terms

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