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| Risk Model of In-Hospital Mortality in 15,183 Patients Requiring Thoracic Surgery: Results from a Nationally Representative Database |
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Back to 86th Annual Meeting Back to Program Outline Objective: To identify factors associated with in-hospital mortality among patients following general thoracic surgery and to construct a risk model that could be used prospectively to inform decisions and retrospectively to enable fair comparisons and outcomes. Methods: Data from a nationally representative thoracic surgery database were collected prospectively in 59 hospitals between June 1, 2002 and July 1, 2005. Only adult patients with more than 95% of completed data were selected for the final analysis (n=15,183 patients). Logistic regression analysis was used to predict the risk of in-hospital mortality. A prediction rule was developed on a training set of data (n=10,122; 2/3 of patients) and validated on an independent test set (n=5,061; 1/3 of patients). The model's fit was assessed by the Hosmer-Lemeshow test (larger p value means better reliability), and predictive accuracy was assessed by the area under the receiver operating characteristic curve (c-index). Results: Of the 15,183 original patients, 338 (2.2%) died during the same hospital admission. Within the data used to develop the model, these factors were found to be significantly associated with the occurrence of in-hospital mortality in a multivariate analysis: age, gender, dyspnea (according to the Medical Research Council classification), ASA (American Society of Anaesthesiologists) score, performance status (World Health Organization) classification, presence of comorbid disease, localization (lung or pleura versus mediastinum), diagnosis group (malignant versus otherwise), class of procedure (lobectomy or wedge resection versus pneumonectomy), and priority of surgery. The model was reliable (Hosmer-Lemeshow test = 8.94; p=0.35) and accurate: c-index (95% confidence interval) = 0.85 (0.83 to 0.87) for the training set and 0.86 (0.83 to 0.89) for the test set of data. The correlation between the expected and observed number of deaths was 0.99. Conclusions: The validated multivariate model for risk of in-hospital mortality among adult patients following general thoracic surgery described in this report was developed with national data, uses only 10 variables and has good performance characteristics. It appears to be a valid clinical tool for predicting the risk of death. Hence, it would be useful both for calculating the mortality risk of an individual patient and for contrasting expected and observed mortality rates for an institution or independent clinician. Back to 86th Annual Meeting Back to Program Outline |
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