A Bayesian hierarchical approach to comparative audit for carotid surgery

Kuhan, G.; Marshall, E.C.; Abidia, A.F.; Chetter, I.C.; McCollum, P.T.

Abstract

Objectives: the aim of this study was to illustrate how a Bayesian hierarchical modelling approach can aid the reliable comparison of outcome rates between surgeons. Design: retrospective analysis of prospective and retrospective data. Materials: binary outcome data (death/stroke within 30 days), together with information on 15 possible risk factors specific for CEA were available on 836 CEAs performed by four vascular surgeons from 1992-99. The median patient age was 68 (range 38-86) years and 60% were men. Methods: the model was developed using the WinBUGS software. After adjusting for patient-level risk factors, a cross-validatory approach was adopted to identify "divergent" performance. A ranking exercise was also carried out. Results: the overall observed 30-day stroke/death rate was 3.9% (33/836). The model found diabetes, stroke and heart disease to be significant risk factors. There was no significant difference between the predicted and observed outcome rates for any surgeon (Bayesian p-value > 0.05). Each surgeon had a median rank of 3 with associated 95% CI 1.0-5.0, despite the variability of observed stroke/death rate from 2.9-4.4%. After risk adjustment, there was very little residual between-surgeon variability in outcome rate. Conclusions: Bayesian hierarchical models can help to accurately quantify the uncertainty associated with surgeons' performance and rank.

Citation

Kuhan, G., Marshall, E., Abidia, A., Chetter, I., & McCollum, P. (2002). A Bayesian hierarchical approach to comparative audit for carotid surgery. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 24(6), 505-510. https://doi.org/10.1053/ejvs.2002.1763

• Journal Article Type: Article
• Acceptance Date: Aug 13, 2002
• Online Publication Date: Nov 14, 2002
• Publication Date: 2002-12
• Journal: European Journal of Vascular and Endovascular Surgery
• Print ISSN: 1078-5884
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 6
• Pages: 505-510
• DOI: https://doi.org/10.1053/ejvs.2002.1763
• Keywords: Carotid endarterectomy; Comparative audit; Hierarchical models; Bayesian analysis; WinBUGS
• Public URL: https://hull-repository.worktribe.com/output/432628
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1078588402917636?via%3Dihub