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Myocardial Infarction After Vascular Surgery—Reply
JAMA Surgery ( IF 16.9 ) Pub Date : 2018-05-01 , DOI: 10.1001/jamasurg.2017.6144
Yen-Yi Juo 1, 2 , Boback Ziaeian 3 , Peyman Benharash 1, 4
Affiliation  

In Reply We read with great interest the letter by Polok et al regarding our article1 and appreciate their insightful comments, which highlight several challenges in the use of retrospective databases for quality monitoring. However, several key factors deserve further consideration.

The initial question prompting our study was whether recent innovations in research and technology translated into actual improvements in patient outcomes from 2005 to 2014. To objectively answer this question, we used the largest longitudinally collected and validated surgical database in the United States, the American College of Surgeons National Surgical Quality Improvement Program.2 However, as surgical practice has evolved over time, so too have methods of data collection. For example, our study covered trends from 2005 to 2014, during which time the definition of postoperative myocardial infarction was modified twice.3 In our study,1 definitions for events were standardized per National Surgical Quality Improvement Program registry definitions and protocols, which is itself constantly evolving to optimize modeling and adjust for complex patient and procedural risk profiles.4 We acknowledge the challenges in maintaining consistency of myocardial infarction definition across the study period. Yet this point leads to one of our highlighted findings: the Myocardial Infarction and Cardiac Arrest calculator, initially developed and validated prior to the most recent revision of the myocardial infarction definition,5 was found to consistently underestimate myocardial infarction risk.1 We agree with Polok et al that higher-quality cohort data with uniform characterization of patient characteristics and adjudication of postoperative events would be ideal for developing and validating future risk assessment tools.



中文翻译:

血管手术后心肌梗塞—回复

在回复中,我们怀着极大的兴趣阅读了 Polok 等人关于我们文章1的来信,并感谢他们富有洞察力的评论,这些评论强调了使用回顾性数据库进行质量监控的几个挑战。然而,有几个关键因素值得进一步考虑。

促使我们研究的最初问题是,最近的研究和技术创新是否转化为 2005 年至 2014 年患者结果的实际改善。为了客观地回答这个问题,我们使用了美国最大的纵向收集和验证的手术数据库,美国学院外科医生国家外科质量改进计划。2然而,随着外科实践的发展,数据收集方法也随之发展。例如,我们的研究涵盖了 2005 年至 2014 年的趋势,在此期间,术后心肌梗死的定义被修改了两次。3在我们的研究中,1事件的定义根据国家外科质量改进计划登记定义和协议进行了标准化,该计划本身不断发展以优化建模并针对复杂的患者和程序风险状况进行调整。4我们承认在整个研究期间保持心肌梗死定义的一致性存在挑战。然而,这一点引出了我们的一项重要发现:心肌梗塞和心脏骤停计算器最初是在心肌梗塞定义的最新修订版之前开发和验证的 5,它被发现始终低估心肌梗塞的风险1个我们同意 Polok 等人的观点,即具有统一表征患者特征和裁定术后事件的高质量队列数据将是开发和验证未来风险评估工具的理想选择。

更新日期:2018-05-16
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