将风险计算器与肺癌切除术患者的脆弱指数进行比较
Dominic J Vitello1,2, Charles D Logan1,2,3, Norah N Zaza1,2
1Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Journal of surgical oncology
|August 29, 2024
概括
美国外科医生学院手术风险计算器 (ACS-SRC) 最好预测肺癌手术中的30天术后不良事件. 它在风险分层方面表现优于修订后的风险分析指数 (RAI-rev) 和修改后的脆弱指数 (5-mFI).
科学领域:
- 手术瘤学手术瘤学
- 胸部外科手术 胸部外科手术
- 医疗保健服务研究 医疗服务研究
背景情况:
- 术后风险分层对于癌症手术中术前规划至关重要.
- 脆弱性评估越来越多地被认为是其在风险分层中的作用.
- 缺乏脆弱性指数和现有的风险计算器之间的直接比较.
研究的目的:
- 为了比较美国外科医生学院手术风险计算器 (ACS-SRC),修订风险分析指数 (RAI-rev) 和修改脆弱指数 (5-mFI) 的风险分层表现.
- 评估这些工具对肺癌切除后的关键术后结果的预测性歧视.
主要方法:
- 从ACS NSQIP数据库 (2012-2014) 中确定了一组9663名为非小细胞肺癌进行解剖肺切除的患者.
- 使用ACS-SRC,RAI-rev和5-mFI来预测30天的术后发病率,死亡率,计划外的再入院,计划外的重新手术和出院处置.
- 使用接收器操作曲线 (AUC) 下的面积进行了预测性歧视的比较分析.
主要成果:
- 在ACS-SRC中,所有主要结局都显示出最高的歧视,包括30天死亡率 (AUC=0.74).
- 与ACS-SRC相比,RAI-rev (AUC=0.66) 和5-mFI (AUC=0.61) 显示出类似的,但较低的预测歧视.
- 该研究包括一大群接受肺切除的患者,报告的30天发病率和死亡率分别为10.9%和1.6%.
结论:
- ACS-SRC是最有效的外科手术期间风险分层工具,用于预测为癌症进行解剖肺切除的患者的30天术后不良事件.
- RAI-rev和5-mFI表现出相似的预测能力,这些能力低于该患者群体的ACS-SRC.
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