Shunsuke Endo1,2, Norihiko Ikeda3,4, Takashi Kondo3,5, Jun Nakajima3,6, Haruhiko Kondo3,7, Yoshihisa Shimada3,4, Masami Sato3,8, Shinichi Toyooka3,9, Yoshinori Okada3,10, Yukio Sato3,11, Ichiro Yoshino3,12, Morihito Okada3,13, Meinoshin Okumura3,14, Masayuki Chida3,15, Eriko Fukuchi16, Hiroaki Miyata16. 1. Japanese Association for Chest Surgery, 3F Chiyoda Seimei Kyoto Oike Building 200 Takamiya-cho, Takakura-Oike-dori, Nakagyo-ku, 604-0835, Kyoto, Japan. tcvshun@jichi.ac.jp. 2. Department of Thoracic Surgery, Jichi Medical University, Tochigi, Japan. tcvshun@jichi.ac.jp. 3. Japanese Association for Chest Surgery, 3F Chiyoda Seimei Kyoto Oike Building 200 Takamiya-cho, Takakura-Oike-dori, Nakagyo-ku, 604-0835, Kyoto, Japan. 4. Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan. 5. Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, Japan. 6. Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan. 7. Department of General Thoracic Surgery, Kyorin University Hospital, Tokyo, Japan. 8. Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. 9. Department of Thoracic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan. 10. Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Miyagi, Japan. 11. Faculty of Medicine, Department of Thoracic Surgery, University of Tsukuba, Ibaraki, Japan. 12. Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 13. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. 14. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 15. Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan. 16. Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
Abstract
BACKGROUND: Broncho-pleural fistula (BPF) and respiratory failure (RF) are life-threatening complications after lung cancer surgery and can result in long-term hospitalization and decreased quality of life. Risk assessments for BPF and RF in addition to mortality and major morbidities are indispensable in surgical decision-making and perioperative care. METHODS: The characteristics and operative data of 80,095 patients who had undergone lung cancer surgery were derived from the 2014 and 2015 National Clinical Database (NCD) of Japan datasets. After excluding 1501 patients, risk models were developed from these data and validated by another dataset for 42,352 patients derived from the 2016 NCD dataset. Receiver operating characteristic curves were generated for postoperative BPF and RF development. The concordance-index was used to assess the discriminatory ability and validity of the model. RESULTS: BPF and RF occurred in 259 (0.3%) and 420 patients (0.5%), respectively, in the model development dataset and in 129 (0.3%) and 198 patients (0.5%), respectively, in the model validation dataset. Characteristic variables including types of surgery and comorbidities were identified as risk factors for BPF and RF, respectively. The concordance indexes of assessments for BPF and RF were 0.847 (p < 0.001) and 0.848 (p < 0.001), respectively, for the development dataset and 0.850 (p < 0.001) and 0.844 (p < 0.001), respectively, for the validation dataset. CONCLUSIONS: These models are satisfactory for predicting BPF and RF after lung cancer surgery in Japan and could guide preoperative assessment and optimal measures for preventing BPF and RF.
BACKGROUND:Broncho-pleural fistula (BPF) and respiratory failure (RF) are life-threatening complications after lung cancer surgery and can result in long-term hospitalization and decreased quality of life. Risk assessments for BPF and RF in addition to mortality and major morbidities are indispensable in surgical decision-making and perioperative care. METHODS: The characteristics and operative data of 80,095 patients who had undergone lung cancer surgery were derived from the 2014 and 2015 National Clinical Database (NCD) of Japan datasets. After excluding 1501 patients, risk models were developed from these data and validated by another dataset for 42,352 patients derived from the 2016 NCD dataset. Receiver operating characteristic curves were generated for postoperative BPF and RF development. The concordance-index was used to assess the discriminatory ability and validity of the model. RESULTS: BPF and RF occurred in 259 (0.3%) and 420 patients (0.5%), respectively, in the model development dataset and in 129 (0.3%) and 198 patients (0.5%), respectively, in the model validation dataset. Characteristic variables including types of surgery and comorbidities were identified as risk factors for BPF and RF, respectively. The concordance indexes of assessments for BPF and RF were 0.847 (p < 0.001) and 0.848 (p < 0.001), respectively, for the development dataset and 0.850 (p < 0.001) and 0.844 (p < 0.001), respectively, for the validation dataset. CONCLUSIONS: These models are satisfactory for predicting BPF and RF after lung cancer surgery in Japan and could guide preoperative assessment and optimal measures for preventing BPF and RF.
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