title: A Predictive Score for Bronchopleural Fistula Established Using the French Database Epithor.
abstract: BACKGROUND
  Bronchopleural fistula (BPF) remains a rare but fatal complication of thoracic surgery. The aim of this study was to develop and validate a predictive model of BPF after pulmonary resection and to identify patients at high risk for BPF.
  
  
  METHODS
  From January 2005 to December 2012, 34,000 patients underwent major pulmonary resection (lobectomy, bilobectomy, or pneumonectomy) and were entered into the French National database Epithor. The primary outcome was the occurrence of postoperative BPF at 30 days. The logistic regression model was built using a backward stepwise variable selection.
  
  
  RESULTS
  Bronchopleural fistula occurred in 318 patients (0.94%); its prevalence was 0.5% for lobectomy (n = 139), 2.2% for bilobectomy (n = 39), and 3% for pneumonectomy (n = 140). The mortality rate was 25.9% for lobectomy (n = 36), 16.7% for bilobectomy (n = 6), and 20% for pneumonectomy (n = 28). In the final model, nine variables were selected: sex, body mass index, dyspnea score, number of comorbidities per patient, bilobectomy, pneumonectomy, emergency surgery, sleeve resection, and the side of the resection. In the development data set, the C-index was 0.8 (95% confidence interval: 0.78 to 0.82). This model was well calibrated because the Hosmer-Lemeshow test was not significant (χ(2) = 10.5, p = 0.23). We then calculated the logistic regression coefficient to build the predictive score for BPF.
  
  
  CONCLUSIONS
  This strong model could be easily used by surgeons to identify patient at high risk for BPF. This score needs to be confirmed prospectively in an independent cohort.
authors: Centre Hospitalier Universitaire (CHU) Dijon, Bocage Hospital, Dijon, France.
authors: Arnaud
authors: A
authors: Pforr
authors: Centre Hospitalier Universitaire (CHU) Dijon, Bocage Hospital, Dijon, France. Electronic address: pierrebenoit.pages@chu-dijon.fr.
authors: Pierre-Benoit
authors: PB
authors: Pagès
authors: CHU Rouen, Charles Nicolle Hospital, Rouen, France.
authors: Jean-Marc
authors: JM
authors: Baste
authors: CHU Marseille, North Hospital, Marseille, France.
authors: Pascal
authors: P
authors: Thomas
authors: CHU Strasbourg, Civil Hospital, Strasbourg, France.
authors: Pierre-Emmanuel
authors: PE
authors: Falcoz
authors: Georges Pompidou European Hospital, Paris, France.
authors: Francoise
authors: F
authors: Lepimpec Barthes
authors: CHU Toulouse, Larrey Hospital, Toulouse, France.
authors: Marcel
authors: M
authors: Dahan
authors: Centre Hospitalier Universitaire (CHU) Dijon, Bocage Hospital, Dijon, France.
authors: Alain
authors: A
authors: Bernard
mesh_terms: D001983:Bronchial Fistula / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010995:Pleural Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011013:Pneumonectomy / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends