Key result
A novel nomogram incorporating nine independent risk factors demonstrated promising predictive efficacy for postoperative pulmonary complications in elderly patients undergoing thoracic surgery, with an AUC of 0.739 in the training cohort.
Why the study?
Postoperative pulmonary complications are prevalent in elderly surgical patients, with a notably higher incidence in thoracic surgery, necessitating a model to predict risk in this population.
Cohort (n=2,963)
No
A newly developed nomogram incorporating nine clinical and surgical factors demonstrated acceptable accuracy in predicting the risk of postoperative pulmonary complications in elderly patients undergoing thoracic surgery.
May support preoperative PPC risk assessment in elderly thoracic patients; leaves open prospective validation before clinical use.
BACKGROUND: Postoperative pulmonary complications (PPCs) remain a prevalent concern among elderly patients undergoing surgery, with a notably higher incidence observed in elderly patients undergoing thoracic surgery. This study aimed to develop a nomogram to predict the risk of PPCs in this population. METHODS: A total of 2963 elderly patients who underwent thoracic surgery were enrolled and randomly divided into a training cohort (80%, n = 2369) or a validation cohort (20%, n = 593). Univariate and multivariate logistic regression analyses were conducted to identify risk factors for PPCs, and a nomogram was developed based on the findings from the training cohort. The validation cohort was used to validate the model. The predictive accuracy of the model was evaluated by receiver operating characteristic (ROC) curve, area under ROC (AUC), calibration curve, and decision curve analysis (DCA). RESULTS: ) level, surgical site, thoracotomy, intraoperative hypotension, blood loss > 100 mL, surgery duration > 180 min, and malignant tumor. The AUC value for the training cohort was 0.739 (95% CI: 0.719-0.762), and it was 0.703 for the validation cohort (95% CI: 0.657-0.749). The P-values for the Hosmer-Lemeshow test were 0.633 and 0.144 for the training and validation cohorts, respectively, indicating a notable calibration curve fit. The DCA curve indicated that the nomogram could be applied clinically if the risk threshold was between 12% and 84%, which was found to be between 8% and 82% in the validation cohort. CONCLUSION: This study highlighted the pressing need for early detection of PPCs in elderly patients undergoing thoracic surgery. The nomogram exhibited promising predictive efficacy for PPCs in elderly patients undergoing thoracic surgery, enabling the identification of high-risk patients and consequently aiding in the implementation of preventive interventions.
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Liu et al. (2024) conducted a cohort in Elderly patients undergoing thoracic surgery (n=2,963). Nomogram incorporating nine clinical risk factors was evaluated on Predictive accuracy for postoperative pulmonary complications (PPCs) within 30 days (AUC 0.739, 95% CI 0.719-0.762). A novel nomogram incorporating nine independent risk factors demonstrated promising predictive efficacy for postoperative pulmonary complications in elderly patients undergoing thoracic surgery, with an AUC of 0.739 in the training cohort.
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