A nomogram to predict postoperative pulmonary complications after cardiothoracic surgery,The Journal of Thoracic and Cardiovascular Surgery

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A nomogram to predict postoperative pulmonary complications after cardiothoracic surgery
The Journal of Thoracic and Cardiovascular Surgery ( IF 4.9 ) Pub Date : 2021-08-20 , DOI: 10.1016/j.jtcvs.2021.08.034
Ashish K Khanna ₁ , Marta Kelava ₂ , Sanchit Ahuja ₃ , Natalya Makarova ₄ , Chen Liang ₄ , Donna Tanner ₅ , Steven R Insler ₆

Affiliation

Objective

The objective was to develop a novel scoring system that would be predictive of postoperative pulmonary complications in critically ill patients after cardiac and major vascular surgery.

Methods

A total of 17,433 postoperative patients after coronary artery bypass graft, valve, or thoracic aorta repair surgery admitted to the cardiovascular intensive care units at Cleveland Clinic Main Campus from 2009 to 2015. The primary outcome was the composite of postoperative pulmonary complications, including pneumonia, prolonged postoperative mechanical ventilation (>48 hours), or reintubation occurring during the hospital stay. Elastic net logistic regression was used on the training subset to build a prediction model that included perioperative predictors. Five-fold cross-validation was used to select an appropriate subset of the predictors. The predictive efficacy was assessed with calibration and discrimination statistics. Post hoc, of 13,353 adult patients, we tested the clinical usefulness of our risk prediction model on 12,956 patients who underwent surgery from 2015 to 2019.

Results

Postoperative pulmonary complications were observed in 1669 patients (9.6%). A prediction model that included baseline and demographic risk factors along with perioperative predictors had a C-statistic of 0.87 (95% confidence interval, 0.86-0.88), with a corrected Brier score of 0.06. Our prediction model maintains satisfactory discrimination (C-statistics of 0.87) and calibration (Brier score of 0.07) abilities when evaluated on an independent dataset of 12,843 recent adult patients who underwent cardiovascular surgery.

Conclusions

A novel prediction nomogram accurately predicted postoperative pulmonary complications after major cardiac and vascular surgery. Intensivists may use these predictors to allow for proactive and preventative interventions in this patient population.

中文翻译：

预测心胸外科术后肺部并发症的列线图

客观的

目的是开发一种新的评分系统，该系统可以预测危重患者在心脏和大血管手术后的术后肺部并发症。

方法

2009 年至 2015 年，共有 17,433 名接受冠状动脉旁路移植术、瓣膜或胸主动脉修复手术的术后患者入住克利夫兰诊所主校区的心血管重症监护病房。主要结果是术后肺部并发症的综合结果，包括肺炎、术后机械通气时间延长（>48 小时），或在住院期间重新插管。弹力网对训练子集使用逻辑回归来构建包括围手术期预测因子的预测模型。使用五重交叉验证来选择预测变量的适当子集。通过校准和鉴别统计评估预测功效。事后，我们在 13,353 名成年患者中测试了我们的风险预测模型对 2015 年至 2019 年接受手术的 12,956 名患者的临床实用性。

结果

在 1669 名患者 (9.6%) 中观察到术后肺部并发症。包括基线和人口统计学风险因素以及围手术期预测因素的预测模型的 C 统计量为 0.87（95% 置信区间，0.86-0.88），校正后的 Brier 评分为 0.06。当对 12,843 名最近接受心血管手术的成年患者的独立数据集进行评估时，我们的预测模型保持令人满意的辨别力（C 统计量为 0.87）和校准（Brier 评分为 0.07）能力。