The Thoracic Surgery Scoring System (Thoracoscore): Risk model for in-hospital death in 15,183 patients requiring thoracic surgery

被引:211
作者
Falcoz, Pierre Emmanuel
Conti, Massimo
Brouchet, Laurent
Chocron, Sidney
Puyraveau, Marc
Mercier, Mariette
Etievent, Joseph Philippe
Dahan, Marcel
机构
[1] Hop Jean Minjoz, Dept Thorac & Cardiovasc Surg, F-25000 Besancon, France
[2] Calmette Hosp, Dept Thorac Surg, Lille, France
[3] Larrey Hosp, Dept Thorac Surg, Toulouse, France
[4] Hop St Jacques, Clin & Biol Res Ctr, F-25030 Besancon, France
[5] Sch Med, Dept Biostat & Epidemiol, Besancon, France
关键词
D O I
10.1016/j.jtcvs.2006.09.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: This study was undertaken to determine factors associated with in-hospital mortality among patients after general thoracic surgery and to construct a risk model. Methods: Data from a nationally representative thoracic surgery database were collected prospectively between June 2002 and July 2005. Logistic regression analysis was used to predict the risk of in-hospital death. A risk model was developed with a training set of data (two thirds of patients) and validated on an independent test set (one third of patients). Model fit was assessed by the Hosmer-Lemeshow test; predictive accuracy was assessed by the c-index. Results: Of the 15,183 original patients, 338 (2.2%) died during the same hospital admission. Within the data used to develop the model, these factors were found to be significantly associated with the occurrence of in-hospital death in a multivariate analysis: age, sex, dyspnea score, American Society of Anesthesiologists score, performance status classification, priority of surgery, diagnosis group, procedure class, and comorbid disease. The model was reliable (Hosmer-Lemeshow test 3.22; P = .92) and accurate, with a c-index of 0.85 (95% confidence interval 0.83-0.87) for the training set and 0.86 (95% confidence interval 0.83-0.89) for the test set of data. The correlation between the expected and observed number of deaths was 0.99. Conclusions: The validated multivariate model Thoracoscore, described in this report for risk of in-hospital death among adult patients after general thoracic surgery was developed with national data, uses only 9 variables, and has good performance characteristics. It appears to be a valid clinical tool for predicting the risk of death.
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页码:325 / 332
页数:8
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