HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by D’Errigo, P. Articles by Perucci, C. A. Search for Related Content PubMed Articles by D’Errigo, P. Articles by Perucci, C. A.

Letters to the Editor

Re: Editorial comment by Dr Menicanti

^a National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella, 34, I-00161 Rome, Italy
^b Department of Epidemiology, ASL RME, Rome, Italy

Received 21 March 2008; received in revised form 28 March 2008; accepted 29 April 2008.

^_* Corresponding author. Tel.: +39 06 49904236; fax: +39 06 49904230. (Email: paola.derrigo{at}iss.it).

Key Words: Coronary artery bypass graft • Risk-adjustment • EuroSCORE

Results from the Italian CABG Outcome Project were published two years ago, generating controversial reactions among cardiac surgeons and a stimulating debate within the NHS.

Actually, the debate contributed to important advances in the systematic introduction of outcome evaluation and comparison within the Italian NHS. A national outcomes project has been developed since then; also a second round of the CABG study is currently ongoing, thanks to the key and enthusiastic cooperation of a significant number of Italian cardiac surgeons.

Apart from the expected dissent by professionals and hospitals whose performances resulted not so well, and their efforts to prevent us from publishing any kind of paper dealing with the Italian CABG Outcome Project, we know that the CABG study represents a substantial source of scientific evidence. Therefore, one year ago we published further papers dealing with the comparison of MLR and multilevel models in outcome studies and comparison between administrative and clinical databases [1,2]. On this specific occasion, we published a paper concerning the comparison between a local risk-adjustment model and the well-established EuroSCORE model [3].

We know Dr Menicanti never misses an opportunity to disagree with works dealing with the Italian CABG Outcome Project and, as in other previous occasions, his criticisms are directed towards the study per se rather than towards specific topics of the paper. Therefore, about 90% of the arisen questions are the same reported in other editorials concerning the Italian CABG study and which we have already largely replied to in previous published correspondences [4,5].

In this occasion we prefer to point out only a few issues.

The first is related to considerations about the study design. Actually, taking into account the objectives of the study, the appropriate study design was chosen before the study started. We confirm that a study designed as prospective does not become retrospective only because the data are analyzed some years after they have been collected.

The second deals with the citation from Dr Akins. We are sure the statistical analyses used in this paper are too elementary to be judged a ‘number torture’ to obtain the required results. The analyses only confirmed some expected results and led to already known considerations about the EuroSCORE topicality. In this work, we have tried to compare EuroSCORE and CABG models. Although ‘comparisons’ represent interesting and informative analyses, epidemiologists know that a complete variable definition overlapping between studies is quite impossible to reach. We often have to accept intermediate situations, provided that differences are declared in advance and findings interpreted with caution. This concept suits our usual behavior and represents what we actually did in this work.

In conclusion, debate on results represents a worthy instrument for the development of scientific research. This is true also for outcome research studies, which can be carried out only with the contribution of different professional figures. Each of them with his own knowledge and limits, admitting and respecting competence and values of all the others. Unfortunately, this does not always happen!

References

1. D’Errigo P, Tosti ME, Fusco D, Perucci CA, Seccareccia F, on behalf of the research group of the Italian CABG Outcome Study Use of hierarchical models to evaluate performance of cardiac surgery centres in the Italian CABG outcome study. BMC Med Res Methodol 2007.
2. Rosato S, D’Errigo P, Badoni G, Fusco D, Perucci CA, Seccareccia F. Comparison between administrative and clinical databases in the evaluation of cardiac surgery performances. G Ital Cardiol, in press.
3. D’Errigo P, Seccareccia F, Rosato S, Manno V, Badoni G, Fusco D, Perucci CA, and the Research group of the Italian CABG Outcome Project Eur J Cardiothorac Surg 2008;33:325-333.[Abstract/Free Full Text]
4. Seccareccia F, Perucci CA, D’Errigo P, Fusco D. Concerning the Editorial comment by Dr Menicanti. Eur J Cardiothorac Surg 2006;29(5):858-859.[Free Full Text]
5. Seccareccia F, Perucci CA, D’Errigo P, Fusco D. Corrispondenza: reply to Dr Menicanti. G Ital Cardiol 2006;7:653-655.

This article has been cited by other articles:

				L. A. Menicanti Reply to d'errico et Al. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 469 - 469. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by D’Errigo, P. Articles by Perucci, C. A. Search for Related Content PubMed Articles by D’Errigo, P. Articles by Perucci, C. A.