External validation of six existing multivariable clinical prediction models for short-term mortality in patients undergoing lung resection

Marcus Taylor, Bartłomiej Szafron, Glen P Martin, Udo Abah, Matthew Smith, Michael Shackcloth, Felice Granato, Rajesh Shah, Stuart W Grant

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Abstract

OBJECTIVES
National guidelines advocate the use of clinical prediction models to estimate perioperative mortality for patients undergoing lung resection. Several models have been developed that may potentially be useful but contemporary external validation studies are lacking. The aim of this study was to validate existing models in a multicentre patient cohort.

METHODS
The Thoracoscore, Modified Thoracoscore, Eurolung, Modified Eurolung, European Society Objective Score and Brunelli models were validated using a database of 6600 patients who underwent lung resection between 2012 and 2018. Models were validated for in-hospital or 30-day mortality (depending on intended outcome of each model) and also for 90-day mortality. Model calibration (calibration intercept, calibration slope, observed to expected ratio and calibration plots) and discrimination (area under receiver operating characteristic curve) were assessed as measures of model performance.

RESULTS
Mean age was 66.8 years (±10.9 years) and 49.7% (n = 3281) of patients were male. In-hospital, 30-day, perioperative (in-hospital or 30-day) and 90-day mortality were 1.5% (n = 99), 1.4% (n = 93), 1.8% (n = 121) and 3.1% (n = 204), respectively. Model area under the receiver operating characteristic curves ranged from 0.67 to 0.73. Calibration was inadequate in five models and mortality was significantly overestimated in five models. No model was able to adequately predict 90-day mortality.

CONCLUSIONS
Five of the validated models were poorly calibrated and had inadequate discriminatory ability. The modified Eurolung model demonstrated adequate statistical performance but lacked clinical validity. Development of accurate models that can be used to estimate the contemporary risk of lung resection is required.
Original languageEnglish
Pages (from-to)1030-1036
Number of pages7
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume59
Issue number5
Early online date24 Nov 2020
DOIs
Publication statusPublished - 1 May 2021

Keywords

  • Lung resection
  • Ninety-day mortality
  • Perioperative mortality
  • Risk models

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