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Thoracoscore: Does it predict mortality in the Indian scenario? - A retrospective study
Archana Pathy1, Prachi Kar1, Ramachandran Gopinath1
1Department of Anaesthesia and Intensive Care, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India.
Indian Journal of Anaesthesia
|October 20, 2022
Summary
The Thoracoscore, a tool for predicting surgical risk, was found to be inaccurate for Indian patients undergoing thoracic surgery. This study highlights the need for population-specific risk assessment tools in surgery.
Area of Science:
- Cardiothoracic Surgery
- Surgical Risk Assessment
- Health Outcomes Research
Background:
- Preoperative risk stratification is crucial for patient prognostication and resource allocation in surgery.
- Risk scoring models are underutilized in thoracic surgery.
- The Thoracoscore, developed in France, requires validation in diverse populations.
Purpose of the Study:
- To validate the efficacy of the Thoracoscore in predicting mortality among Indian patients undergoing thoracic surgery.
- To assess the performance of the Thoracoscore in a tertiary care setting within India.
Main Methods:
- A retrospective analysis of patients undergoing posterolateral thoracotomy for lung pathologies between January 2014 and December 2018.
- Collected data included Thoracoscore variables, additional factors (pulmonary arterial hypertension, redo surgery), and observed mortality.
- Statistical analysis involved t-tests, Chi-square tests, multivariate logistic regression, Hosmer-Lemeshow test, and ROC curve analysis to evaluate calibration and discrimination.
Main Results:
- Observed mortality was 3.2%, significantly higher than the predicted mortality of 0.44% by Thoracoscore.
- The Thoracoscore demonstrated poor calibration and fair discrimination ability in this cohort.
- Pulmonary arterial hypertension and re-operative surgery were identified as independent risk factors for mortality.
Conclusions:
- The Thoracoscore is not a reliable predictor of mortality in the Indian population undergoing thoracic surgery.
- There is a critical need for developing and validating region-specific risk assessment tools for thoracic surgery.
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