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Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection
Dominic J Vitello1,2, Charles D Logan1,2,3, Norah N Zaza1,2
1Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Journal of Surgical Oncology
|October 10, 2024
Summary
The American College of Surgeons Surgical Risk Calculator (ACS-SRC) best predicts 30-day postoperative adverse events in lung cancer surgery. Frailty indices showed similar, but lower, predictive accuracy for these outcomes.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Geriatric Surgery
Background:
- Frailty is increasingly used for risk stratification in surgical patients.
- No studies have directly compared frailty indices against established risk calculators.
- This study addresses the need for comparative analysis of risk stratification tools.
Purpose of the Study:
- To compare the risk stratification performance of the American College of Surgeons Surgical Risk Calculator (ACS-SRC), Revised Risk Analysis Index (RAI-rev), and Modified Frailty Index (5-mFI).
- To evaluate these tools' ability to predict 30-day postoperative morbidity, mortality, unplanned readmission, unplanned reoperation, and non-home discharge.
- To determine the optimal tool for risk assessment in patients undergoing lung cancer resection.
Main Methods:
- Retrospective analysis of patients undergoing anatomic lung resection for non-small cell lung cancer from the ACS National Quality Improvement Program (ACS NSQIP) database (2012-2014).
- Comparison of discrimination for primary outcomes using area under the receiver operating curve (AUC) and confidence intervals (CIs).
- Inclusion of 9663 patients, assessing demographic and outcome data.
Main Results:
- The ACS-SRC demonstrated the highest discrimination for all measured 30-day adverse postoperative outcomes.
- For perioperative mortality, ACS-SRC achieved an AUC of 0.74 (95% CI 0.71-0.78), outperforming RAI-rev (AUC 0.66) and 5-mFI (AUC 0.61).
- The RAI-rev and 5-mFI exhibited similar predictive discrimination for all outcomes, which was lower than ACS-SRC.
Conclusions:
- The ACS-SRC is the superior perioperative risk stratification tool for predicting adverse 30-day postoperative events in patients undergoing anatomic lung resection for cancer.
- Frailty indices (RAI-rev and 5-mFI) offer comparable, yet less precise, risk stratification compared to ACS-SRC.
- These findings support the use of ACS-SRC for enhanced risk assessment in this patient population.
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