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Introduction Lung cancer is the leading cause of cancer-related deaths worldwide. Surgery remains the best treatment for obtaining a cure in patients in resectable stages. Despite the improvements in surgical techniques, perioperative complications are still a major factor of mortality. Several scoring systems for quantifying surgical risks have been proposed but they require large and complex information, usually regarding specific groups or postoperative mortality. Objectives Identify risk factors for major in-hospital perioperative complications (MIPC) after anatomical lung resection for Non- -Small-Cell Lung Cancer (NSCLC) establish a clinical scoring system. Materials and Methods Single center retrospective study of all consecutive patients diagnosed with NSCLC submitted to anatomical lung resection from 2015 to 2019 (N=564). Exclusion criteria: previous lung surgery (29), concomitant non-lung cancer related procedures (10), urgency surgery (5). The population of study was 520 patients. Primary end-point: MIPC defined as a composite endpoint including at least one of the following in-hospital variables - myocardial infarction, cardiac arrest, de novo Atrial Fibrillation, stroke, acute renal lesion, bleeding, acute pulmonary edema, primary respiratory failure, respiratory infection, empyema, sepsis, wound infection and need for reoperation.Univariable and Multivariable analyses were developed to identify predictors of perioperative complications and create a risk score. Discrimination was assessed using the C-statistic. Calibration was evaluated by Hosmer and Lemeshow test and internal validation was obtained by means of bootstrap replication. Results The study population had a mean age of 65 years and 327 (62.9%) were males. Mean hospital stay of 9 days after surgery. Overall MIPC rate was 23.3%.Among 26 clinical variables, male gender (OR 1.9; CI95%:1.16-3.07; p=0.010), hypertension (OR 2.1; CI95%:1.35-3.37; p=0,001), forced expiratory volume in 1s (FEV1) less than 75% (OR 2.5; CI95%:1.53-1.17; p<0.001), thoracotomy (OR 2.1; CI95%:1.20-3.57; p=0.009), bilobectomy/pneumectomy (OR 2.5; CI95%:1.2-4.9; p=0.011) and concomitant lung cancer procedures (OR 2.1; CI95%:1.20-3.58; p=0.009) were independent predictors of MIPC. A risk score based on the odds ratios was developed and ranged between 0 and 14 points. The scoring system was divided in 5 groups: 1-2 points (Positive predicted value (PPV) 15%); 3-4 (PPV 25%); 5-7 (PPV 35%); 8-9 (PPV 60%); >10 points (PPV 88%). The score showed reasonable discrimination (C-statistic=0.70), good calibration (P=.643) and it was internally validated (averaged C-statistic=0,71). Conclusions This study proposes a simple and daily-life risk score system that was able to predict the incidence of perioperative complications, in order to identify patients at a high risk and facilitate clinical decision-making related to treatment strategy selection.
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PMID:Lung Resection For Non-Small-Cell Lung Cancer - A New Risk Score To Predict Major Perioperative Complications. 3328 Feb 97


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