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The National Surgical Quality Improvement Program risk calculator does not adequately stratify risk for patients with clinical stage I non–small cell lung cancer.

Authors :
Samson, Pamela
Robinson, Clifford G.
Bradley, Jeffrey
Lee, Audrey
Broderick, Stephen
Kreisel, Daniel
Krupnick, A. Sasha
Patterson, G. Alexander
Puri, Varun
Meyers, Bryan F.
Crabtree, Traves
Source :
Journal of Thoracic & Cardiovascular Surgery; Mar2016, Vol. 151 Issue 3, p697-705.e1, 1p
Publication Year :
2016

Abstract

Objective The study objective was to validate the National Surgical Quality Improvement Program (NSQIP) Risk Calculator in stratifying risk estimates for patients who received surgery or stereotactic body radiation therapy for clinical stage I non–small cell lung cancer. Methods A retrospective analysis of patients with clinical stage I non–small cell lung cancer undergoing surgery (N = 279) or stereotactic body radiation therapy (N = 206) from 2009 to 2012 was performed. NSQIP complication risk estimates were calculated for both surgical and stereotactic body radiation therapy cases using the NSQIP Surgical Risk Calculator. NSQIP complication risk estimates were compared as continuous variables and by quartile ranges. Results Compared with patients undergoing video-assisted thoracoscopic surgery wedge resection, patients receiving stereotactic body radiation therapy were older, had larger tumors, had lower forced expiratory volume (FEV 1 ) in 1 second and diffusing capacity of the lungs (DLCO) for carbon monoxide values, had higher American Society of Anesthesiologists scores, had higher rates of dyspnea, and had higher NSQIP serious complication risk estimates (all P < .05). Compared with patients undergoing video-assisted thoracoscopic surgery lobectomy, patients receiving stereotactic body radiation therapy had similar disparities, along with higher Adult Comorbidity Evaluation-27 (ACE) scores comorbidity scores, higher rates of cardiac comorbidities, and worse functional status (all P < .05). Variables associated with receiving stereotactic body radiation therapy treatment, rather than wedge resection, included increasing age, higher Adult Comorbidity Evaluation (ACE)-27 comorbidity score, dyspnea status, and decreasing FEV 1 in 1 second and DLCO for carbon monoxide, but NSQIP serious complication risk score. In addition, surgical patients' actual serious complication rate (16.6% vs 8.8%) and pneumonia rate (6.0% vs 3.2%) were significantly higher than the NSQIP risk calculator predicted (all P < .05). Conclusions The National Surgical Quality Improvement Program risk calculator does not effectively classify or stratify risk in patients with stage I non–small cell lung cancer. Continued efforts are needed to assess risk in this population and develop more tailored treatment decision aids. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00225223
Volume :
151
Issue :
3
Database :
Supplemental Index
Journal :
Journal of Thoracic & Cardiovascular Surgery
Publication Type :
Academic Journal
Accession number :
113052645
Full Text :
https://doi.org/10.1016/j.jtcvs.2015.08.058