Royal Brisbane and Women's Hospital data fitted to the Australian Endovascular Aneurysm Repair Risk Assessment (ERA) Model

[摘要] The Endovascular Aneurysm Repair Risk Assessment (ERA) Model was developed in 2007 using data obtained from an Australian audit of 961 Australian patients who underwent endovascular aortic aneurysm repair (EVAR).This ERA Model can be used preoperatively to predict the likelihood of specific outcomes for patients about to undergo EVAR surgery.In this report the predictive performance of the ERA model is evaluated on a new cohort of patients from Royal Brisbane and Women's Hospital (RBWH) Queensland. The performance of the model on this new cohort (197 patients) is compared with its predictive performance on the original 961 Australian EVAR patients used to develop the model. The ERA Model enables clinicians to enter up to eight preoperative variables for a patient, in order to derive the predicted likelihood of endpoints such as early death, aneurysm-related death, survival, type I endoleaks and mid-term re-interventions. RBWH Queensland provided data from 197 patients who had EVARs between 11 April 1994 and 1 July 2009. This report summarises the external validation of the ERA model by comparing the actual outcomes of the RBWH patients to the predicted outcomes made using the ERA model. Generally RBWH patients were sicker (had higher ASA score), had smaller aneurysms (p 0.001), had longer necks (p 0.001), and had large neck angles than the ASERNIP-S audit data used to build the ERA Model.The ERA model fitted RBWH data well for early death, initial type I endoleaks, three-year and five-year survival. In fact the RBWH data fit these outcomes better than ERA Model data as evidenced by higher area under Receiver Operating Characteristic (ROC) curves and/or higher R-squared goodness of fit statistic. That the ERA model performed well on predictions of death and conversely survival is pleasing as these are arguably the most important end points. This pleasing external validation suggests that the ERA model may be useful into the future.Previously data from St George’s Vascular Unit London also fitted the ERA Model well suggesting it’s potential internationally. It also suggested the ERA model is robust and appears to be applicable beyond Australia’s pre-operative variable ranges.The models estimating the likelihood of requiring an additional intervention or having type II endoleaks performed poorly, with low ROC area and low R-squared, indicating room for improvement for these outcomes.During the next four years substantial work will be put into testing and improving the ERA Model based on the outcomes of a new Australian study and the supply of data from other international trials.

[发布日期] 2010-07-25 [发布机构] CSIRO

[学科分类] 地球科学(综合)