Tsvetkov Nikolay, Mallaev Makhmudbek, Gahl Brigitta, Hojski Aljaz, Tamm Michael, Steiner Luzius A, Lardinois Didier
Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
Surgical Outcome Research Centre, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
J Thorac Dis. 2024 Sep 30;16(9):5698-5708. doi: 10.21037/jtd-24-611. Epub 2024 Sep 26.
Advances in medicine and surgical techniques make it possible to operate on selected comorbid elderly patients for whom risk assessment is essential. We aimed to validate the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator specifically for thoracic surgery.
This study retrospectively included 283 consecutive patients who all underwent various thoracic surgeries at our center. Considering "serious complication" as the most important outcome, we compared the predicted risk scores with the observed incidence of 30-day morbidity and mortality. We calculated the area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals for each outcome and utilized the Brier score to check the calibration and complication odds ratios above vs. below average risk in all score outcomes with the number of occurred events.
In our study population, most patients were <65 years old (48%), predominantly male (63%), and overweight or obese (48%). In addition, 13% had severe chronic obstructive pulmonary disease (COPD), and 75% were categorized as American Society of Anesthesiologists (ASA) class III or higher. For "serious complication", AUROC was 59%, and events were equal in patients with above or below average risk scores (P=0.96). AUROC was 67% for "any complication" and 58% for "return to OR", expressing no useful predictive value. The Brier score and odds ratios were low for all outcomes. Dyspnea, ASA class, COPD, and body mass index as single postoperative risk predictors significantly improved the basic model consisting of the logit of the risk calculator alone. Thus, the calculator alone did not perform as well as these single variables did.
The ACS NSQIP surgical risk calculator exhibited low sensitivity, specificity, and low AUROC for postoperative 30-day morbidity and mortality in our study cohort. Therefore, we think it cannot be considered as valid risk estimation tool for general thoracic surgery.
医学和外科技术的进步使得为部分患有合并症的老年患者进行手术成为可能，而风险评估对他们至关重要。我们旨在验证美国外科医师学会国家外科质量改进计划（ACS NSQIP）手术风险计算器在胸外科手术中的有效性。
本研究回顾性纳入了在我们中心连续接受各种胸外科手术的283例患者。将“严重并发症”视为最重要的结局，我们比较了预测风险评分与观察到的30天发病率和死亡率。我们计算了每个结局的受试者工作特征曲线下面积（AUROC）及其95%置信区间，并使用Brier评分来检查校准情况以及所有评分结局中高于或低于平均风险的并发症比值比与发生事件数的关系。
在我们的研究人群中，大多数患者年龄小于65岁（48%），以男性为主（63%），超重或肥胖（48%）。此外，13%患有严重慢性阻塞性肺疾病（COPD），75%被归类为美国麻醉医师协会（ASA）Ⅲ级或更高级别。对于“严重并发症”，AUROC为59%，风险评分高于或低于平均水平的患者发生事件的情况相同（P = 0.96）。“任何并发症”的AUROC为67%，“返回手术室”的AUROC为58%，均无有用的预测价值。所有结局的Brier评分和比值比都很低。呼吸困难、ASA分级、COPD和体重指数作为单一术后风险预测指标，显著改善了仅由风险计算器的对数组成的基本模型。因此，仅风险计算器的表现不如这些单一变量。
在我们的研究队列中，ACS NSQIP手术风险计算器对术后30天发病率和死亡率的敏感性、特异性及AUROC均较低。因此，我们认为它不能被视为普通胸外科手术有效的风险评估工具。
