How to Put Survival After Cardiothoracic Interventions in the General Population Context: A Case-Based Practical Guideline to Calculate Cumulative Matched-General-Population Survival

医学 背景(考古学) 心理干预 指南 人口 重症监护医学 护理部 环境卫生 病理 古生物学 生物
作者
Xu Wang,Maximiliaan L. Notenboom,Kevin M. Veen,Pepijn Grashuis,Eleni‐Rosalina Andrinopoulou,Jonathan R.G. Etnel,Ad J.J.C. Bogers,Mostafa M. Mokhles,Johanna J.M. Takkenberg
出处
期刊:Circulation-cardiovascular Quality and Outcomes [Lippincott Williams & Wilkins]
标识
DOI:10.1161/circoutcomes.123.009993
摘要

Observed patient survival after cardiothoracic interventions should ideally be placed in the context of matched-general-population survival. This study outlines several methodologies of matching general population mortality to the study sample, subsequently calculating cumulative matched-general-population survival, highlighting their respective advantages, disadvantages, and limitations. A multicenter data set containing survival data after the Ross procedure was used for methodological illustration. General population mortality was extracted from country-specific life tables in the Human Mortality Database. The matched-general-population mortality, also known as background mortality, was obtained by matching general population mortality to the study sample using different matching strategies, iteratively considering median/individual age and median/individual calendar year, besides country and sex. The corresponding cumulative matched-general-population survival was calculated subsequently. Sensitivity analyses were performed to assess the impact of varying patient ages on survival estimates by adding and subtracting 15 years from individual patients. A web-based Shiny Application (App) was developed to easily calculate cumulative matched-general-population survival. In total, 1431 hospital survivors from the Ross procedure from 5 countries (25.7% female; median age, 48.5 [interquartile range, 42.7-54.0] years) were included. Fifteen-year survival was 88.3% (95% CI, 85.3-90.6). Cumulative matched-general-population 15-year survival varied from 87.7% to 89.8% using the 3 methods of different complexities. For 15-year-older patients, the cumulative matched-general-population 15-year survival was 67.4%, 59.8%, and 63.2%, respectively, using the simplest to the most comprehensive matching methods; for 15-year-younger patients, it was 96.9%, 96.1%, and 96.7%, respectively. Different methodologies to match general population mortality to observed patient mortality yield variable estimates of cumulative matched-general-population survival, especially in older patients. The cumulative matched-general-population survival should ideally be calculated by considering country, sex, individual patient age, and calendar year (both updated annually). This method can be easily implemented using the web-based Shiny App enclosed in this article.
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