Abstract
Assessment of the association between risk factors and outcomes in cardiac surgery is a complex problem. The aim of this study was to explore the relationship between possible risk factors and several clinical outcomes in cardiac surgery by using canonical correlation analysis (CCA). This retrospective study of 2605 consecutive adult patients who underwent cardiac surgery, evaluated 74 potential risk factors and up to 12 outcomes by canonical correlation analysis. For three serious outcomes, sternal wound complications/mediastinitis, cerebral complications, and perioperative myocardial infarctions, CCA was preceded by univariate analyses and backward stepwise multivariate logistic regression analyses. The CCA suggests that the major risk factors for complications in these models are intraoperative and postoperative risk factors. The power of risk prediction models developed with multivariate regression analysis can be enhanced by application of canonical correlation analysis, thereby offering new ways of analyzing and interpreting sets of potential risk factors in relation to sets of clinical outcomes.
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Higgins, T. L., Quantifying risk and assessing outcome in cardiac surgery. J. Cardiothorac. Vasc. Anesth. 12:330–340, 1998.
Higgins, T. L., Estafanous, F. G., Loop, F. D., Beck, G. J., Blum, J. M., and Paranandi, L., Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score (published erratum appears in JAMA} 1992 Oct 14;268:1860 (see comments). JAMA 267:2344–2348, 1992.
Parsonnet, V., Bernstein, A. D., Gera, M., Clinical usefulness of risk-stratified outcome analysis in cardiac surgery in New Jersey. Ann. Thorac. Surg. 61:S8–S11, 1996.
O’Connor, G. T., Plume, S. K., Olmstead, E. M., et al., Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. Circulation 85:2110–2118, 1992.
Tu, J. V., Jaglal, S. B., and Naylor, CD, Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. The Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation 91:677–684, 1995.
Roques, F., Nashef, S. A. M., Michel, P., et al., Risk factors and outcome in European cardiac surgery: Analysis of the EuroSCORE multinational database of 19030 patients. J. Cardiothorac. Surg. 15:816–823, 1999.
Nashef, S. A. M., Roques, F., Michel P., Gauducheau E., Lemeshow S., and Salamon R., European system for cardiac operative risk evaluation (EuroSCORE). The EuroSCORE study group. Eur. J. Cardiothorac. Surg. 16:9–13, 1999.
Nashef, S. A. M., Roques, F., Michel P., et al., Coronary surgery in Europe: Comparison of the national subsets of the European system for cardiac operative risk evaluation database. J. Cardiothorac. Surg. 17:396–399, 2000.
Pitkänen, O., Niskanen, M., Rehnberg, S., Hippeläinen, M., Hynynen, M., Intra-institutional prediction of outcome after cardiac surgery: Comparison between a locally derived model and the EuroSCORE. Eur. J. Cardiothorac. Surg. 18:703–710, 2000.
Sergeant, P., de Worm, E., and Meyns, B., Single centre, single domain validation of the EuroSCORE on a consecutive sample of primary and repeat CABG. Eur. J. Cardiothorac. Surg. 20:1176–1182, 2001.
Ridderstolpe, L., Gill, H., Granfeldt, H., AÅhlfeldt, H., and Rutberg, H., Superficial and deep sternal wound complications: Incidence, risk factors, and mortality. Eur. J. Cardiothorac. Surg. 20:1168–1175, 2001.
Ridderstolpe, L., Ahlgren, E., Gill, H., and Rutberg H., Risk factor analysis of early and delayed cerebral complications after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 16:278–285, 2002.
Hotelling, H., Relations between two sets of variates. Biometrika 28:321–377, 1936.
Anderson, T. W, An introduction to multivariate statistical analysis. Wiley, New York, 2nd ed., 1984.
Borga M., Learning multidimensional signal processing. PhD thesis, Linköping University, Sweden, SE-581 83 Linköping, Sweden, 1998. Dissertation No. 531, ISBN 91-7219-202-X.
Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., Jarvis, W. R., Guideline for prevention of surgical site infection. The Hospital Infection Control Practices Advisory Committee. Infect. Control Hosp. Epidemiol. 20:247–278, 1999.
Roach, G. W., Kanchuger, M., Mangano, C. M., et al., Adverse cerebral outcomes after coronary bypass surgery. The Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N. Engl. J. Med. 335:1857–1863, 1996.
Fisher, R. A., Design of experiments, Hafner, New York, 1935.
Efron, B., and Tibshirani, R. J., An introduction to the bootstrap, Chapman & Hall, New York, 1993.
Roques, F., Nashef, S. A. M., Michel, P., Pinna Pintor, P., David, M., and Baudet, E., Does EuroSCORE work in individual European countries? The EuroSCORE study group. Eur. J. Cardiothorac. Surg. 18:27–30, 2000.
Orr, R. K., Maini, B. S., Sottile, F. D., Dumas, E. M., and O’Mara P., A comparison of four severity-adjusted models to predict mortality after coronary artery bypass graft surgery. Arch. Surg. 130:301–306, 1995.
Dahlin, L. G., Olin, C., and Svedjeholm, R., Perioperative myocardial infarction in cardiac surgery: Risk factors and consequences. Scand. Cardiovasc. J. 34:522–527, 2000.
Svedjeholm, R., Håkanson, R., Szabó, Z., and Vánky F. Neurological injury after surgery for ischemic heart disease: Risk factors, outcome, and role of metabolic interventions. Eur. J. Cardiothorac. Surg. 19:611–618, 2001.
Higgins, T. L., Yared, J.-P., and Ryan, T., Immediate postoperative care of cardiac surgical patients. J. Cardiothorac. Vasc. Anesth. 10:643–658, 1996.
Higgins, T. L., Estafanous, F. G., Loop, F. D., et al., ICU admission score for predicting morbidity and mortality risk after coronary artery bypass grafting. Ann. Thorac. Surg. 64:1050–1058, 1997.
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Ridderstolpe, L., Gill, H., Borga, M. et al. Canonical Correlation Analysis of Risk Factors and Clinical Outcomes in Cardiac Surgery. J Med Syst 29, 357–377 (2005). https://doi.org/10.1007/s10916-005-5895-9
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DOI: https://doi.org/10.1007/s10916-005-5895-9