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(Circulation. 2008;118:S153-S159.)
© 2008 American Heart Association, Inc.

Surgery for Aortic Diseases

Risk Model of Thoracic Aortic Surgery in 4707 Cases From a Nationwide Single-Race Population Through a Web-Based Data Entry System

The First Report of 30-Day and 30-Day Operative Outcome Risk Models for Thoracic Aortic Surgery

Noboru Motomura, MD, PhD, FAHA; Hiroaki Miyata, PhD; Hiroyuki Tsukihara, MD, PhD; Shinichi Takamoto, MD, PhD; from the Japan Cardiovascular Surgery Database Organization

From the. Departments of Cardiothoracic Surgery (N.M., S.T.) and Healthcare Quality Assessment (N.M., H.M., H.T.), Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Correspondence to Noboru Motomura, MD, PhD, FAHA, Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail noboru{at}motomura.org

Background— The objective of this study was to collect integrated data from nationwide hospitals using a web-based national database system to build up our own risk model for the outcome from thoracic aortic surgery.

Methods and Results— The Japan Adult Cardiovascular Surgery Database was used; this involved approximately 180 hospitals throughout Japan through a web-based data entry system. Variables and definitions are almost identical to the STS National Database. After data cleanup, 4707 records were analyzed from 97 hospitals (between January 1, 2000, and December 31, 2005). Mean age was 66.5 years. Preoperatively, the incidence of chronic lung disease was 11%, renal failure was 9%, and rupture or malperfusion was 10%. The incidence of the location along the aorta requiring replacement surgery (including overlapping areas) was: aortic root, 10%; ascending aorta, 47%; aortic arch, 44%; distal arch, 21%; descending aorta, 27%; and thoracoabdominal aorta, 8%. Raw 30-day and 30-day operative mortality rates were 6.7% and 8.6%, respectively. Postoperative incidence of permanent stroke was 6.1%, and renal failure requiring dialysis was 6.7%. OR for 30-day operative mortality was as follows: emergency or salvage, 3.7; creatinine >3.0 mg/dL, 3.0; and unexpected coronary artery bypass graft, 2.6. As a performance metric of the risk model, C-index of 30-day and 30-day operative mortality was 0.79 and 0.78, respectively.

Conclusion— This is the first report of risk stratification on thoracic aortic surgery using a nationwide surgical database. Although condition of these patients undergoing thoracic aortic surgery was much more serious than other procedures, the result of this series was excellent.

Key Words: aneurysm • aorta • risk factor • risk model • surgery