Vitello Dominic J, Logan Charles D, Zaza Norah N, Bates Kelly R, Jacobs Ryan, Feinglass Joseph, Merkow Ryan P, Bentrem David J
Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA.
J Surg Oncol. 2024 Oct;130(5):1111-1118. doi: 10.1002/jso.27815. Epub 2024 Aug 29.
Perioperative risk stratification is an essential component of preoperative planning for cancer surgery. While frailty has gained attention for its utility in risk stratification, no studies have directly compared it to existing risk calculators. Therefore, the objective of this study was to compare the risk stratification of the American College of Surgeons Surgical Risk Calculator (ACS-SRC), the Revised Risk Analysis Index (RAI-rev), and the Modified Frailty Index (5-mFI). The primary outcomes were 30-day postoperative morbidity, 30-day postoperative mortality, unplanned readmission, unplanned reoperation, and discharge disposition other-than-home.
Patients undergoing anatomic lung resection for primary, non-small cell lung cancer were identified within the American College of Surgeons National Quality Improvement Program (ACS NSQIP) database. The ACS-SRC, RAI-rev, and 5-mFI tools were used to predict adverse postoperative events. Tools were compared for discrimination in the primary outcomes.
9663 patients undergoing anatomic lung resection for cancer between 2012 and 2014 were included. The cohort was 53.1% female. Median age at diagnosis was 67 (interquartile range = 59-74) years. Cardiothoracic surgeons performed 89% and general surgeons performed 11.0% of the operations. Perioperative morbidity and mortality rates were 10.9% (n = 1048) and 1.6% (n = 158). Rates of 30-day postoperative unplanned readmission and reoperation were 7.5% (n = 725) and 4.8% (n = 468). The ACS-SRC had the highest discrimination for all measured outcomes, as measured by the area under the receiver operating curve (AUC) and corresponding confidence interval (95% confidence interval [CI]). This included perioperative mortality (AUC = 0.74, 95% CI = 0.71-0.78), compared to RAI-rev (AUC = 0.66, 95% CI = 0.62-0.69) and 5-mFI (AUC = 0.61, 95% CI = 0.57-0.65; p < 0.001). The RAI-rev and 5-mFI had similar discrimination for all measured outcomes.
ACS-SRC was the perioperative risk stratification tool with the highest predictive discrimination for adverse, 30-day, postoperative events for patients with cancer treated with anatomic lung resection.
围手术期风险分层是癌症手术术前规划的重要组成部分。虽然虚弱因其在风险分层中的作用而受到关注，但尚无研究将其与现有的风险计算器进行直接比较。因此，本研究的目的是比较美国外科医师学会手术风险计算器（ACS-SRC）、修订风险分析指数（RAI-rev）和改良虚弱指数（5-mFI）的风险分层。主要结局包括术后30天发病率、术后30天死亡率、计划外再入院、计划外再次手术以及非回家的出院处置。
在美国外科医师学会国家质量改进计划（ACS NSQIP）数据库中识别接受解剖性肺切除治疗原发性非小细胞肺癌的患者。使用ACS-SRC、RAI-rev和5-mFI工具预测术后不良事件。比较这些工具在主要结局方面的辨别能力。
纳入了2012年至2014年间9663例接受癌症解剖性肺切除的患者。该队列中女性占53.1%。诊断时的中位年龄为67岁（四分位间距=59-74岁）。心胸外科医生实施了89%的手术，普通外科医生实施了11.0%的手术。围手术期发病率和死亡率分别为10.9%（n=1048）和1.6%（n=158）。术后30天计划外再入院率和再次手术率分别为7.5%（n=725）和4.8%（n=468）。根据受试者工作特征曲线下面积（AUC）及其相应的置信区间（95%置信区间[CI]）测量，ACS-SRC在所有测量结局方面的辨别能力最高。这包括围手术期死亡率（AUC=0.74，95%CI=0.71-0.78），相比之下RAI-rev（AUC=0.66，95%CI=0.62-0.69）和5-mFI（AUC=0.61，95%CI=0.57-0.65；p<0.001）。RAI-rev和5-mFI在所有测量结局方面的辨别能力相似。
对于接受解剖性肺切除治疗的癌症患者，ACS-SRC是对术后30天不良事件预测辨别能力最高的围手术期风险分层工具。
