General thoracic surgery
Risk model of in-hospital mortality after pulmonary resection for cancer: A national database of the French Society of Thoracic and Cardiovascular Surgery (Epithor)

https://doi.org/10.1016/j.jtcvs.2010.06.044Get rights and content
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Objectives

The estimation of risk-adjusted in-hospital mortality is essential to allow each thoracic surgery team to be compared with national benchmarks. The objective of this study is to develop and validate a risk model of mortality after pulmonary resection.

Methods

A total of 18,049 lung resections for non–small cell lung cancer were entered into the French national database Epithor. The primary outcome was in-hospital mortality. Two independent analyses were performed with comorbidity variables. The first analysis included variables as independent predictive binary comorbidities (model 1). The second analysis included the number of comorbidities per patient (model 2).

Results

In model 1 predictors for mortality were age, sex, American Society of Anesthesiologists score, performance status, forced expiratory volume (as a percentage), body mass index (in kilograms per meter squared), side, type of lung resection,extended resection, stage, chronic bronchitis, cardiac arrhythmia, coronary artery disease, congestive heart failure, alcoholism, history of malignant disease, and prior thoracic surgery. In model 2 predictors were age, sex, American Society of Anesthesiologists score, performance status, forced expiratory volume, body mass index, side, type of lung resection, extended resection, stage, and number of comorbidities per patient. Models 1 and 2 were well calibrated, with a slope correction factor of 0.96 and of 0.972, respectively. The area under the receiver operating characteristic curve was 0.784 (95% confidence interval, 0.76–0.8) in model 1 and 0.78 (95% confidence interval, 0.76–0.797) in model 2.

Conclusions

Our preference is for the well-calibrated model 2 because it is easier to use in practice to estimate the adjusted postoperative mortality of lung resections for cancer.

CTSNet classification

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Abbreviations and Acronyms

ASA
American Society of Anesthesiologists
AUC
area under the curve
BMI
body mass index
CI
confidence interval
Dlco
diffusion capacity for carbon monoxide
FEV
forced expiratory volume
ROC
receiver operating characteristic

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Disclosures: Authors have nothing to disclose with regard to commercial support.