Validation and update of the thoracic surgery scoring system (Thoracoscore) risk model
Validation and update of the thoracic surgery scoring system (Thoracoscore) risk model
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DOI：
10.1093/ejcts/ezaa056
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发表时间：
2020-08-01
影响因子：
3.4
通讯作者：
Dahan, Marcel
中科院分区：
文献类型：
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作者：
Loucou, Julien Die;Pages, Pierre-Benoit;Dahan, Marcel
目的：随着时间的推移，预测模型的性能趋于恶化。本研究的目的是利用上皮国家胸外科数据库的最新数据更新Thoracoscore风险预测模型。方法：2016年1月至2017年12月，共56279例因纵隔、胸膜、胸壁或肺部疾病进行手术的患者。我们采用3种推荐方法对Thoracoscore预测模型进行更新，进而建立新的风险模型。30天住院死亡率包括在手术前30天内死亡的患者和在同一住院期间死亡的患者。结果：我们比较了用于开发Thoracoscore预测模型的原始数据和验证数据中的基线患者特征。年龄分布不同，验证组中年龄大于65岁的患者特别多。在验证组中，视频辅助胸腔镜占手术的47%，而在原始数据中仅占18%。校正曲线用于更新Thoracoscore，证实了3种方法的过拟合。Hosmer-Lemeshow拟合优度检验对3个更新模型具有显著性。验证数据中存在过拟合系数（美国麻醉医师学会评分、工作状态和手术类别）。Hosmer-Lemeshow拟合优度检验表明，新风险模型校正正确，不显著。新风险模型的c指数较强（0.84），证实了新风险模型区分有无结果患者的能力。结论：新的Thoracoscore风险模型具有更好的性能和良好的校准，适合目前的临床实践使用。
OBJECTIVES: The performance of prediction models tends to deteriorate over time. The purpose of this study was to update the Thoracoscore risk prediction model with recent data from the Epithor nationwide thoracic surgery database.METHODS: From January 2016 to December 2017, a total of 56279 patients were operated on for mediastinal, pleural, chest wall or lung disease. We used 3 recommended methods to update the Thoracoscore prediction model and then proceeded to develop a new risk model. Thirty-day hospital mortality included patients who died within the first 30days of the operation and those who died later during the same hospital stay.RESULTS: We compared the baseline patient characteristics in the original data used to develop the Thoracoscore prediction model and the validation data. The age distribution was different, with specifically more patients older than 65years in the validation group. Video-assisted thoracoscopy accounted for 47% of surgeries in the validation group compared but only 18% in the original data. The calibration curve used to update the Thoracoscore confirmed the overfitting of the 3 methods. The Hosmer-Lemeshow goodness-of-fit test was significant for the 3 updated models. Some coefficients were overfitted (American Society of Anesthesiologists score, performance status and procedure class) in the validation data. The new risk model has a correct calibration as indicated by the Hosmer-Lemeshow goodness-of-fit test, which was non-significant. The C-index was strong for the new risk model (0.84), confirming the ability of the new risk model to differentiate patients with and without the outcome. Internal validation shows no overfitting for the new modelCONCLUSIONS: The new Thoracoscore risk model has improved performance and good calibration, making it appropriate for use in current clinical practice.