To compare an expert panel's global assessment of appropriateness of elective surgery for abdominal aortic aneurysms (AAA) with their assessment of the effect of surgery on the probability of 5-year mortality.
Nine expert panel members rated the appropriateness of 120 scenarios for elective AAA repair on a nine-point scale, and also estimated the 5-year probability of AAA-related death and of non-AAA related death among 30-day survivors of AAA surgery and among patients with unoperated AAA.
These probabilities were used to determine differences in 5-year probablility of mortality of surgery vs. no surgery for each scenario.
Three categories of appropriateness were defined based on these differences : inappropriate (<0%), equivocal (0-5%), and appropriate (>5%). Results : the distribution of scenarios was inappropriate (39%), equivocal (12%), and appropriate (49%) based on probability estimates and inappropriate (43%), equivocal (22%), and appropriate (36%) based on global assessment.
There was poor agreement between the two methods, with a Kappa coefficient=0.28 (95% CI : 0.23 to 0.32).
Although a higher proportion of scenarios were rated as appropriate using probability estimation rather than global judgment, the level of agreement among members of the panel was similar, Kappa coefficient=0.07 (95% CI : 0.07 to 0.72).
Experts disagree about the appropriate indications for elective surgery for AAA. (...)
Mots-clés Pascal : Evaluation, Méthodologie, Maladie, Mortalité, Information, Santé, Expert, Obésité, Trouble nutrition, Stress, Santé mentale, Chirurgie, Spécialité médicale, Appareil circulatoire pathologie, Anévrysme, Indicateur, Mesure, Trouble anxieux, Vaisseau sanguin pathologie
Mots-clés Pascal anglais : Evaluation, Methodology, Disease, Mortality, Information, Health, Expert, Obesity, Nutrition disorder, Stress, Mental health, Surgery, Medical specialty, Cardiovascular disease, Aneurysm, Indicator, Measurement, Anxiety disorder, Vascular disease
Notice produite par :
ORS Auvergne - Observatoire Régional de la Santé d'Auvergne
Code Inist : 002B30A11. Création : 19/02/1999.