title: Thoracoscore fails to predict complications following elective lung resection.
abstract: The Thoracoscore mortality risk model has been incorporated into the British Thoracic Society guidelines on the radical management of patients with lung cancer. The discriminative and predictive ability to predict mortality and post-operative pulmonary complications (PPCs) in this group of patients is uncertain. A prospective observational study was carried out on all patients following lung resection via thoracotomy in a regional thoracic centre over 42 months. 128 out of 703 subjects developed a PPC. 16 (2%) patients died in hospital. In a logistic regression analysis the Thoracoscore was not a significant predictor of mortality (OR 1.07, 95% CI 0.99-1.17; p=0.11) but was a significant predictor of PPCs (OR 1.08, 95% CI 1.03-1.13; p=0.002). However, the area under the receiver operator characteristic curve for the Thoracoscore was 0.68 (95% CI 0.56-0.80) for predicting mortality and 0.64 (95% CI 0.59-0.69) for PPCs, indicating limited discriminative ability. In a logistic regression analysis, another risk model, the European Society Objective Score, was predictive of mortality (OR 1.43, 95% CI 1.11-1.83; p=0.006) and PPCs (OR 1.48, 95% CI 1.30-1.68; p<0.0001). Therefore, Thoracoscore may have poor discriminative and predictive ability for mortality and PPCs following elective lung resection.
authors.affiliation: Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Bradley
authors.forename: Andrea
authors.initials: A
authors.lastname: Marshall
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdelaziz
authors.forename: Khalid
authors.initials: K
authors.lastname: Hussain
authors.forename: Paula
authors.initials: P
authors.lastname: Agostini
authors.forename: Ehab
authors.initials: E
authors.lastname: Bishay
authors.forename: Maninder
authors.initials: M
authors.lastname: Kalkat
authors.forename: Richard
authors.initials: R
authors.lastname: Steyn
authors.forename: Pala
authors.initials: P
authors.lastname: Rajesh
authors.forename: Janet
authors.initials: J
authors.lastname: Dunn
authors.forename: Babu
authors.initials: B
authors.lastname: Naidu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D008962:Models, Theoretical; D016017:Odds Ratio; D011183:Postoperative Complications; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000379:methods / Q000592:standards*; D012372:ROC Curve; D012044:Regression Analysis; D012306:Risk; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D006113:United Kingdom