Scholarlink

Background <p>The ARISCAT score, a prospectively developed generic classification for postoperative pulmonary complications (PPCs), has shown excellent predictive performance in general surgery. However, there is no reliable classification instrument for PPCs prediciton in thoracic surgery.</p> Objective <p>This study aimed to develop and validate a novel nomogram for estimating the risk of pulmonary complications in older patients (≥ 65 years) within 30 days after NCTS.</p> Methods <p>A nomogram was developed using predefined candidate predictors of 30-day PPCs. It was fitted with least absolute shrinkage and selection operator and logistic regression methods. Internal validation was performed using a bootstrap-resampling approach, while external validation used an independent, temporally separated cohort. The model’s performance was assessed based on its discriminative potential (area under the receiver operating characteristic curve [AUC]), predictive ability (calibration plots), and clinical utility (net benefit).</p> Results <p>In the development (<i>n</i> = 1449) and validation (n = 449) cohorts, 34.9% and 31.4% of patients, respectively, developed pulmonary complications 30 days post-surgery. The final nomogram incorporated eight predictors (age, surgical approach, desaturation of &lt; 92% for more than 2 min, duration of surgery, smoking status, FEV<sub>1</sub>/FVC%, respiratory infection in the last 30 days, and neoadjuvant chemotherapy). The nomogram showed excellent discrimination (AUC = 0.866, 95% confidence interval [CI], 0.846–0.885), calibration (Hosmer- Lemeshow test, P = 0.97) and overall performance (Brier score = 0.014) in the development cohort. Similar results were observed in the external validation cohort (AUC = 0.825, 95% CI, 0.786–0.864). A decision curve analysis indicated that the nomogram offers a positive net benefit compared with the ARISCAT and LAS VEGAS scores.</p> Conclusions <p>This novel nomogram can reliably identify older patients with a high risk for pulmonary complications within 30 days after NCTS.</p> Trial registration <p>ChiCTR2100051170.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年3月13日

查看全文
  • Yongxin Zhou,
  • Haiyan Wang,
  • Dianyu Lu,
  • Tao Jiang,
  • Zhanpeng Huang,
  • Feixiang Wang,
  • Yonghua Yao,
  • Yu Gu,
  • Wei Wei

摘要

Background

The ARISCAT score, a prospectively developed generic classification for postoperative pulmonary complications (PPCs), has shown excellent predictive performance in general surgery. However, there is no reliable classification instrument for PPCs prediciton in thoracic surgery.

Objective

This study aimed to develop and validate a novel nomogram for estimating the risk of pulmonary complications in older patients (≥ 65 years) within 30 days after NCTS.

Methods

A nomogram was developed using predefined candidate predictors of 30-day PPCs. It was fitted with least absolute shrinkage and selection operator and logistic regression methods. Internal validation was performed using a bootstrap-resampling approach, while external validation used an independent, temporally separated cohort. The model’s performance was assessed based on its discriminative potential (area under the receiver operating characteristic curve [AUC]), predictive ability (calibration plots), and clinical utility (net benefit).

Results

In the development (n = 1449) and validation (n = 449) cohorts, 34.9% and 31.4% of patients, respectively, developed pulmonary complications 30 days post-surgery. The final nomogram incorporated eight predictors (age, surgical approach, desaturation of < 92% for more than 2 min, duration of surgery, smoking status, FEV1/FVC%, respiratory infection in the last 30 days, and neoadjuvant chemotherapy). The nomogram showed excellent discrimination (AUC = 0.866, 95% confidence interval [CI], 0.846–0.885), calibration (Hosmer- Lemeshow test, P = 0.97) and overall performance (Brier score = 0.014) in the development cohort. Similar results were observed in the external validation cohort (AUC = 0.825, 95% CI, 0.786–0.864). A decision curve analysis indicated that the nomogram offers a positive net benefit compared with the ARISCAT and LAS VEGAS scores.

Conclusions

This novel nomogram can reliably identify older patients with a high risk for pulmonary complications within 30 days after NCTS.

Trial registration

ChiCTR2100051170.