Identifying Risk Factors and Creating a Point-Based Risk Calculator for Postoperative Pneumonia in Thoracic Surgery...

Area of Science:

• Thoracic Surgery
• Surgical Quality Improvement
• Predictive Analytics

Background:

• Postoperative pneumonia (POP) is a significant complication following thoracic surgery.
• Accurate identification of patients at high risk for POP is crucial for targeted interventions.
• Existing risk stratification methods may require refinement for thoracic surgery populations.

Purpose of the Study:

• To develop and validate a predictive model for identifying thoracic surgery patients at risk of postoperative pneumonia (POP).
• To identify key preoperative predictors associated with POP in this patient cohort.
• To create a risk-based calculator for clinical use.

Main Methods:

• Secondary data analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) dataset (2013-2022).
• Development and validation of predictive models using logistic regression (Method 1) and Xtreme Gradient Boosting (Method 2).
• Expert panel review (Method 3) and assessment of models using 10-fold cross-validation and Area Under the Receiver Operating Characteristic Curve (AUC ROC).

Main Results:

• Logistic regression identified nine significant preoperative predictors of POP, including sepsis, systemic inflammatory response syndrome, and male gender, achieving a 10-fold cross-validated AUC ROC of 0.72.
• Xtreme Gradient Boosting model achieved a 10-fold cross-validation AUC ROC of 0.75.
• Expert panel assessment resulted in an AUC ROC of 0.6, indicating a poorer classification performance.

Conclusions:

• A predictive model utilizing nine significant preoperative factors effectively identifies thoracic surgery patients at risk for postoperative pneumonia.
• The identified predictors and developed risk calculator can aid clinicians in stratifying patient risk and implementing preventative strategies.
• Further validation and implementation of the risk calculator are warranted to improve patient outcomes in thoracic surgery.