Adjusted Survival Curves Improve Understanding of Multivariable Cox Model Results

Carly S. Lundgreen, Dirk R. Larson, Elizabeth J. Atkinson, Katrina L. Devick, David G. Lewallen, Daniel J. Berry, Hilal Maradit Kremers, Cynthia S. Crowson

Research output: Contribution to journalArticlepeer-review

Abstract

Kaplan-Meier survival curves are the most common methods for unadjusted group comparison of outcomes in orthopedic research. However, they may be misleading due to an imbalance of confounders between patient groups. The Cox model is frequently used to adjust for confounders, but graphical display of adjusted survival curves is not commonly utilized. We describe the circumstances when adjusted survival curves are useful in orthopedic research, describe and use 2 different methods to obtain adjusted curves, and illustrate how they can improve understanding of the multivariable Cox model results. We further provide practical strategies for identifying the need for and performing adjusted survival curves.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - 2021

Keywords

  • confounding
  • Cox model
  • survival analysis
  • survival curves
  • total joint arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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