Evidence map›Paper›PMID 31935435›Full record

ArticleAnnals of vascular surgery2020

Assessment of the Risk Analysis Index for Prediction of Mortality, Major Complications, and Length of Stay in Patients who Underwent Vascular Surgery.

Kara A Rothenberg, Elizabeth L George, Amber W Trickey, Nicolas B Barreto, Theodore M Johnson, Daniel E Hall, Jason M Johanning, Shipra Arya

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of vascular surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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  3. Pooled it
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  6. Clinical Outcomes of 5000 IU Heparin Versus Activated Clotting Time-Guided Heparinization During Noncardiac Arterial Procedures: A Propensity Score Matched Analysis.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2026
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  19. Independent Associations of Neighborhood Deprivation and Patient-level Social Determinants of Health with Textbook Outcomes after Inpatient Surgery.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Kara A RothenbergStanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, CA; Division of Vascular Surgery, Stanford University, Stanford, CA; Department of Surgery, University of California San Francisco - East Bay, Oakland, CA.
Elizabeth L GeorgeStanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, CA; Division of Vascular Surgery, Stanford University, Stanford, CA.
Amber W TrickeyStanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, CA.
Nicolas B BarretoStanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, CA.
Theodore M JohnsonDivision of Geriatrics and General Medicine, Emory University School of Medicine, Atlanta, GA; Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Decatur, GA.
Daniel E HallDepartment of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Wolffe Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA.
Jason M JohanningDivision of Vascular Surgery, University of Nebraska Medical Center, Omaha, NE; Nebraska Western Iowa VA Health System, Omaha, NE.
Shipra AryaStanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, CA; Division of Vascular Surgery, Stanford University, Stanford, CA; Division of Vascular Surgery, Surgical Services Lines, VA Palo Alto Healthcare System, Palo Alto, CA. Electronic address: sarya1@stanford.edu.

Funding

Failure to rescue in frail surgical patientsR03AG050930 · NIA · STANFORD UNIVERSITY · PI ARYA, SHIPRA · 2016 to 2017
$234k
NIA NIH HHS R03 AG050930
6 · The paper itself

Abstract

backgroundFrailty is a risk factor for adverse postoperative outcomes. We aimed to test the performance of a prospectively validated frailty measure, the Risk Analysis Index (RAI) in patients who underwent vascular surgery and delineate the additive impact of procedure complexity on surgical outcomes.

methodsWe queried the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database to identify 6 major elective vascular procedure categories (carotid revascularization, abdominal aortic aneurysm [AAA] repair, suprainguinal revascularization, infrainguinal revascularization, thoracic aortic aneurysm [TAA] repair, and thoracoabdominal aortic aneurysm [TAAA] repair). We trained and tested logistic regression models for 30-day mortality, major complications, and prolonged length of stay (LOS). The first model, "RAI," used the RAI alone; "RAI-Procedure (RAI-P)" included procedure category (e.g., AAA repair) and procedure approach (e.g., endovascular); "RAI-Procedure Complexity (RAI-PC)" added outpatient versus inpatient surgery, general anesthesia use, work relative value units (RVUs), and operative time.

resultsThe RAI model was a good predictor of mortality for vascular procedures overall (C-statistic: 0.72). The C-statistic increased with the RAI-P (0.78), which further improved minimally, with the RAI-PC (0.79). When stratified by procedure category, the RAI predicted mortality well for infrainguinal (0.79) and suprainguinal (0.74) procedures, moderately well for AAA repairs (0.69) and carotid revascularizations (0.70), and poorly for TAAs (0.62) and TAAAs (0.54). For carotid, infrainguinal, and suprainguinal procedures, procedure complexity (RAI-PC) had little impact on model discrimination for mortality, did improve discrimination for AAAs (0.84), TAAs (0.73), and TAAAs (0.80). Although the RAI model was not a good predictor for major complications or LOS, discrimination improved for both with the RAI-PC model.

conclusionsFrailty as measured by the RAI was a good predictor of mortality overall after vascular surgery procedures. Although the RAI was not a strong predictor of major complications or prolonged LOS, the models improved with the addition of procedure characteristics like procedure category and approach.

Indexed as

Clinical Decision RulesFrail ElderlyLength of StayAgedAged, 80 and overDatabases, FactualFemaleFrailtyHealth StatusHumansMaleMiddle AgedPostoperative ComplicationsPredictive Value of TestsRetrospective StudiesRisk Assessment

Identifiers

PMID31935435
PMCPMC7608558

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.