American College of Chest Physicians algorithm for lung resective surgery: Real-life validation

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Surgical Risk Assessment

Background:

• Preoperative evaluation guidelines for resective surgery, including the ACCP algorithm, exist but lack validation in routine clinical practice.
• Assessing patient fitness for thoracic surgery is crucial for optimizing outcomes and minimizing risks.

Purpose of the Study:

• To retrospectively evaluate the validity of the ACCP algorithm in routine clinical practice for thoracic surgery candidates.
• To identify independent risk factors for postoperative mortality following anatomical lung resection.

Main Methods:

• Retrospective cohort study using prospectively collected data from a thoracic surgery registry (2011-2023).
• Analysis included patient demographics, predicted postoperative lung function (PPO FEV1, PPO-DLco), ACCP risk classification, surgical approach (VATS vs. open), and survival outcomes.
• Statistical analysis identified independent risk factors for 30, 60, and 90-day mortality.

Main Results:

• Overall postoperative mortality increased from 3.1% at 30 days to 5.5% at 90 days.
• Independent risk factors for mortality included age >70 years, intermediate ACCP risk classification, and pneumonectomy.
• Video-assisted thoracic surgery (VATS) was associated with reduced mortality risk.

Conclusions:

• The ACCP algorithm remains a valid tool for assessing fitness for anatomical lung resection.
• Consideration of age >70 years and pneumonectomy as intermediate-risk determinants could refine the ACCP algorithm.
• Increasing mortality from 30 to 90 days necessitates careful risk-benefit analysis for therapeutic alternatives.