2024年更新的胸腔外科医生协会短期食道切除风险模型:更具包容性和改进的校准
Jeffrey B Velotta1, Christopher W Seder2, Levi N Bonnell3
1Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California.
The Annals of thoracic surgery
|July 1, 2024
概括
在食道癌患者的食道切除术的最新风险模型显示,准确性有所提高. 这些新模型使用胸部外科医生协会数据库数据,帮助进行手术前风险评估和共享决策.
科学领域:
- 胸部外科手术 胸部外科手术
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 胸腔外科医生协会一般胸腔外科数据库 (STS-GTSD) 之前已经建立了食道切除术的短期风险模型.
- 现有的模型需要更新,以纳入最新的患者数据和额外的临床风险因素.
研究的目的:
- 更新和改进现有的风险预测模型,以治疗食道癌患者的食道切除术.
- 通过包括当代队列和新风险因素来增强术前风险估计.
主要方法:
- 利用STS-GTSD对因食道癌而接受食道切除术的成年患者的数据 (2015年1月 - 2022年12月).
- 使用后勤回归开发了操作死亡率,主要发病率和复合发病率/死亡率的单独风险模型.
- 通过9倍交叉验证,评估歧视和校准验证模型.
主要成果:
- 包括来自254个中心的18503名患者;观察到的死亡率和发病率分别为3.4%和30.5%.
- 确定身体表面积和保险支付人类型作为新型预测因素.
- 与以前的STS-GTSD模型相比,更新的模型显示了类似或更高的歧视 (例如,C-统计=0.72的手术死亡率).
结论:
- 新获得的食道切除风险模型提供了更好的性能和更广泛的应用.
- 这些模型为共享决策,提供者评估和质量改进提供了可靠的手术前风险估计.
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