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External Validation of Surgical Risk Preoperative Assessment System in Pulmonary Resection.

Neel P Chudgar1, Shi Yan2, Meier Hsu1

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The Surgical Risk Preoperative Assessment System (SURPAS) shows moderate predictive ability for pulmonary resection complications. However, caution is advised for specific outcomes like cardiac events and mortality, suggesting potential improvements with additional patient factors.

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Area of Science:

  • Thoracic Surgery
  • Surgical Risk Assessment
  • Predictive Analytics in Medicine

Background:

  • Accurate preoperative risk assessment is crucial for informed surgical decision-making.
  • Existing risk calculators have limited validation in general thoracic surgery.
  • The Surgical Risk Preoperative Assessment System (SURPAS) was developed to predict adverse postoperative outcomes using minimal variables.

Purpose of the Study:

  • To externally validate the performance of SURPAS in predicting postoperative complications.
  • To assess SURPAS's accuracy in patients undergoing pulmonary resection.

Main Methods:

  • Utilized data from 2514 patients undergoing pulmonary resection (2016-2018).
  • Calculated predicted risks for 12 postoperative outcomes using SURPAS.
  • Evaluated SURPAS performance using discrimination (concordance index) and calibration (calibration curves).

Main Results:

  • SURPAS demonstrated moderate discrimination across all outcomes (concordance indices 0.640-0.788).
  • Good calibration was observed for most outcomes.
  • SURPAS overestimated risks for infectious complications, cardiac complications, non-home discharge, and mortality.

Conclusions:

  • SURPAS offers reasonable predictive ability for pulmonary resection outcomes.
  • Clinical judgment is essential when interpreting SURPAS predictions for specific high-risk complications.
  • Incorporating additional factors like sex and pulmonary function may enhance SURPAS accuracy.