风险计算器与肺癌切除术患者的脆弱指数的比较
Dominic J Vitello1,2, Charles D Logan1,2,3, Norah N Zaza1,2
1Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Journal of surgical oncology
|October 10, 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. 脆弱性指数显示了类似的,但较低的,这些结果的预测准确性.
科学领域:
- 胸部外科手术 胸部外科手术
- 手术瘤学手术瘤学
- 老年人手术是一门老年人手术.
背景情况:
- 脆弱性越来越多地用于手术患者的风险分层.
- 没有研究直接将脆弱性指数与已建立的风险计算器进行比较.
- 本研究解决了对风险分层工具进行比较分析的需求.
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.
- 评估这些工具预测30天术后发病率,死亡率,意外再入院,意外再手术和非家庭出院的能力.
- 确定在接受肺癌切除的患者中进行风险评估的最佳工具.
主要方法:
- 从ACS国家质量改进计划 (ACS NSQIP) 数据库 (2012-2014) 进行针对非小细胞肺癌进行解剖肺切除的患者的回顾性分析.
- 用接收器操作曲线下的面积 (AUC) 和置信区间 (CI) 来比较主要结果的歧视.
- 包括9663名患者,评估人口统计和结果数据.
主要成果:
- 在ACS-SRC中,所有测量的30天不良术后结果都显示出最高的歧视.
- 对于术后死亡率,ACS-SRC的AUC达到0.74 (95%CI为0.71-0.78),超过RAI-rev (AUC为0.66) 和5-mFI (AUC为0.61).
- RAI-rev和5-mFI对所有结果都表现出类似的预测歧视,低于ACS-SRC.
结论:
- ACS-SRC是卓越的外科手术期间风险分层工具,用于预测癌症解剖肺切除患者的30天术后不良事件.
- 与ACS-SRC相比,脆弱性指数 (RAI-rev和5-mFI) 提供了相似的,但不那么精确的风险分层.
- 这些发现支持使用ACS-SRC来加强该患者群体的风险评估.
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