Thoracic Service, Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Thoracic Service, Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Thoracic Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China.
J Thorac Cardiovasc Surg. 2022 Apr;163(4):1509-1516.e1. doi: 10.1016/j.jtcvs.2021.01.036. Epub 2021 Jan 21.
The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP SRC) was developed to estimate the risk of postoperative morbidity and mortality within 30 days of an operation. We sought to externally evaluate the performance of the NSQIP SRC for patients undergoing pulmonary resection.
Patients undergoing pulmonary resection at our center between January 2016 and December 2018 were included. Using data from our institution's prospectively maintained Society of Thoracic Surgeons General Thoracic Database, we identified 2514 patients. We entered requisite patient demographic information, preoperative risk factors, and procedural details into the online calculator. Predicted performance of the calculator versus observed outcomes was assessed by discrimination (concordance index [C-index]) and calibration.
The observed and predicted probabilities of any complication were 8.3% and 9.9%, respectively, and of serious complications were 7.4% and 9.2%, respectively. Observed and predicted 30-day mortality were 0.5% and 0.9%, respectively. The C-index for readmission was 0.644; the C-indices corresponding to all other outcomes in the NSQIP SRC ranged from 0.703 to 0.821. Calibration curves indicated excellent calibration for all binary end points, with the exception of renal failure (predicted underestimated observed probabilities), discharge to a nursing or rehabilitation facility (overestimated), and sepsis (overestimated). Correlation between predicted and observed length of stay was moderate (Spearman coefficient, 0.562), and calibration was good.
Except for readmission, renal failure, discharge to a location other than home, and sepsis, the NSQIP SRC can be used to reasonably predict postoperative complications in patients undergoing pulmonary resection.
美国外科医师学会国家手术质量改进计划手术风险计算器（NSQIP SRC）旨在估计手术 30 天内术后发病率和死亡率的风险。我们试图对外科手术肺切除患者的 NSQIP SRC 性能进行评估。
纳入 2016 年 1 月至 2018 年 12 月期间在我中心接受肺切除术的患者。使用来自我院前瞻性维护的胸外科协会普通胸科数据库的数据，我们确定了 2514 例患者。我们将必要的患者人口统计学信息、术前危险因素和手术细节输入在线计算器。通过判别（一致性指数 [C 指数]）和校准来评估计算器的预测性能与观察结果。
观察到的任何并发症和严重并发症的概率分别为 8.3%和 7.4%，预测的概率分别为 9.9%和 9.2%。观察到的和预测的 30 天死亡率分别为 0.5%和 0.9%。再入院的 C 指数为 0.644；NSQIP SRC 中所有其他结局的 C 指数范围为 0.703 至 0.821。除肾衰竭（预测低估观察到的概率）、出院至护理或康复机构（高估）和败血症（高估）外，所有二元终点的校准曲线均表明校准良好。预测和观察到的住院时间之间的相关性适中（Spearman 系数为 0.562），校准效果良好。
除再入院、肾衰竭、出院至非家庭地点和败血症外，NSQIP SRC 可用于合理预测接受肺切除术的患者术后并发症。
