Informed prognosis [corrected] after XXXX repair using predictive modeling techniques [corrected].

@entity1 @entity1274 @entity1028
OBJECTIVE: To identify the best method for the prediction of postoperative mortality in individual @entity1028 ( @entity1028 ) @entity1 by comparing statistical modelling with artificial @entity1274 ' ( @entity1274 ) and clinicians' estimates. METHODS: An observational multicenter study was conducted of prospectively collected postoperative Acute Physiology and Chronic Health Evaluation II data for a 9-year period from 24 intensive care units (ICU) in the Thames region of the United Kingdom. The study cohort consisted of 1205 elective and 546 emergency @entity1028 @entity1 . Four independent physiologic variables-age, acute physiology score, emergency operation, and chronic health evaluation-were used to develop multiple regression and @entity1274 models to predict in-hospital mortality. The models were developed on 75% of the @entity1 population and their validity tested on the remaining 25%. The results from these two models were compared with the observed outcome and clinicians' estimates by using measures of calibration, discrimination, and subgroup analysis. RESULTS: Observed in-hospital mortality for elective surgery was 9.3% (95% confidence interval [CI], 7.7% to 11.1%) and for emergency surgery, 46.7% (95% CI, 42.5 to 51.0%). The @entity1274 and the statistical models were both more accurate than the clinicians' predictions. Only the statistical model was internally valid, however, when applied to the validation set of observations, as evidenced by calibration (Hosmer-Lemeshow C statistic, 14.97; P = .060), discrimination properties (area under receiver operating characteristic curve, 0.869; 95% CI, 0.824 to 0.913), and subgroup analysis. CONCLUSIONS: The prediction of in-hospital mortality in @entity1028 @entity1 by multiple regression is more accurate than clinicians' estimates or @entity1274 modelling. Clinicians can use this statistical model as an objective adjunct to generate informed prognosis.
