Thoracoscore fails to predict complications following elective lung resection

Abstract

The Thoracoscore mortality risk model has been incorporated into the British Thoracic Society guidelines on the radical management of patients with lung cancer. The discriminative and predictive ability to predict mortality and post-operative pulmonary complications (PPCs) in this group of patients is uncertain.A prospective observational study was carried out on all patients following lung resection via thoracotomy in a regional thoracic centre over 42 months. 128 out of 703 subjects developed a PPC. 16 (2%) patients died in hospital. In a logistic regression analysis the Thoracoscore was not a significant predictor of mortality (OR 1.07, 95% CI 0.99-1.17; p50.11) but was a significant predictor of PPCs (OR 1.08, 95% CI 1.03-1.13; p50.002). However, the area under the receiver operator characteristic curve for the Thoracoscore was 0.68 (95% CI 0.56-0.80) for predicting mortality and 0.64 (95% CI 0.59-0.69) for PPCs, indicating limited discriminative ability.In a logistic regression analysis, another risk model, the European Society Objective Score, was predictive of mortality (OR 1.43, 95% CI 1.11-1.83; p50.006) and PPCs (OR 1.48, 95% CI 1.30-1.68; p,0.0001).Therefore, Thoracoscore may have poor discriminative and predictive ability for mortality and PPCs following elective lung resection.

Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit

“…A small study of lung cancer resections in England adds to concerns that Thoracoscore may not have good predictive ability for people with lung cancer 7. Neither score has been validated in a large study of patients with lung cancer, and prospective evaluation needs to be undertaken as a matter of priority.…”

Slow-growing lung cancer as an emerging entity: from screening to clinical management

“…90-day mortality adds another 2-3% to the toll, mainly due to cardiovascular events occurring after discharge, but these data are seldom reported [89,91]. Several risk models have been developed to stratify patients based on their surgical risk; however, their performance is less than ideal [92][93][94].…”

Clinical and quality of life outcomes following anatomical lung resection for lung cancer in high-risk patients

“…[11] The Thoracoscore was also found to be a poor discriminative tool for predicting postoperative pulmonary complications. [12] More recently, the Liverpool group has put forward an alternative risk assessment tool based on a single center experience. [13] They reported that this system was more accurate than both the thoracoscore and ESOS.01 in predicting in-hospital mortality within their patient cohort.…”