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A simple prediction score for postoperative mortality after decortication.

Konstantinos A Zorbas1, Abbas El-Sayed Abbas2, Kimberly J Song3,4

  • 1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.

Journal of Thoracic Disease
|January 22, 2024
PubMed
Summary
This summary is machine-generated.

Lung decortication is a high-risk surgery. A new Decortication Prognostic Score (DPS) identifies patients at increased risk for 30-day mortality, aiding surgical decision-making.

Keywords:
American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)Thoracic surgerydecorticationprognostic scoresurgical outcomes

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Area of Science:

  • Thoracic surgery
  • Surgical outcomes research
  • Medical informatics

Background:

  • Lung decortication, via video-thoracoscopy or thoracotomy, carries significant mortality risk.
  • This risk is often exacerbated by patient comorbidities and the emergent nature of the surgery.
  • Identifying preoperative predictors of mortality is crucial for risk stratification.

Purpose of the Study:

  • To identify unique preoperative characteristics of patients experiencing 30-day postoperative mortality after lung decortication.
  • To develop a prognostic score system to quantify the risk of death following decortication.

Main Methods:

  • Retrospective analysis of 2,315 patients undergoing decortication from the 2015-2017 ACS-NSQIP databases.
  • Multivariable regression models were employed to identify significant risk factors for postoperative death.
  • These significant factors were used to construct the Decortication Prognostic Score (DPS).

Main Results:

  • The overall 30-day mortality rate was 5.6%.
  • Key independent predictors of mortality included disseminated cancer, advanced age, ventilator dependence, and congestive heart failure.
  • The DPS demonstrated a stepwise increase in mortality risk, with scores ≥4 associated with 27.1% mortality.

Conclusions:

  • Preoperative factors effectively predict postoperative mortality after lung decortication.
  • The DPS can assist surgeons in bedside decision-making and identifying high-risk patients.
  • The score may help anticipate complications like re-intubation, ventilation weaning failure, infections, and prolonged hospital stays.