title: Development and validation of a risk score for predicting death after pneumonectomy.
abstract: Pneumonectomy is associated with significant postoperative mortality. This study was undertaken to develop and validate a risk model of mortality following pneumonectomy. We reviewed our prospective database and identified 774 pneumonectomies from a total of 7792 consecutive anatomical lung resections in the years 2003 to 2010 (rate of pneumonectomy: 9.9%). Based on data from 542 pneumonectomies between 2003 and 2007 (i.e., the "discovery set"), a penalized multivariable logistic regression analysis was performed to identify preoperative risk factors. A risk model was developed and validated in an independent data set of 232 pneumonectomies that were performed between 2008 and 2010 (i.e., the "validation set"). Of the 542 patients in the discovery set (DS), 35 patients (6.5%) died after pneumonectomy during the same admission. We developed a risk prediction model for in-hospital mortality following pneumonectomy; that model included age, current alcohol use, coronary artery disease, preoperative leukocyte count and palliative indication as possible risk factors. The risk model was subsequently successfully validated in an independent data set (n = 232) in which 18 patients (7.8%) died following pneumonectomy. For the validation set, the sensitivity of the model was 53.3% (DS: 54.3%), the specificity was 88.0% (DS: 87.4%), the positive predictive value was 26.7% (DS: 22.9%) and the negative predictive value was 95.8% (DS: 96.5%). The Brier score was 0.062 (DS: 0.054). The prediction model is statistically valid and clinically relevant.
authors: Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.
authors: Seyer
authors: S
authors: Safi
authors: Division of Biostatistics, German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany.
authors: Axel
authors: A
authors: Benner
authors: Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.
authors: Janos
authors: J
authors: Walloschek
authors: Division of Biostatistics, German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany.
authors: Maria
authors: M
authors: Renner
authors: Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.
authors: Jan
authors: J
authors: op den Winkel
authors: Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.
authors: Thomas
authors: T
authors: Muley
authors: Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.
authors: Konstantina
authors: K
authors: Storz
authors: Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.
authors: Hendrik
authors: H
authors: Dienemann
authors: Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.
authors: Hans
authors: H
authors: Hoffmann
authors: Department of Thoracic Surgery, St. Vincentius Kliniken Karlsruhe, Karlsruhe, Baden-Württemberg, Germany.
authors: Thomas
authors: T
authors: Schneider
mesh_terms: D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000401:mortality*; D012306:Risk