Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort study
Abstract Background The ARISCAT score, a prospectively developed generic classification for postoperative pulmonary complications (PPCs), has shown excellent predictive performance in general surgery. However, there is no reliable classification instrument for PPCs prediciton in thoracic surgery. Ob...
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BMC
2025-03-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-05791-2 |
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| author | Yongxin Zhou Haiyan Wang Dianyu Lu Tao Jiang Zhanpeng Huang Feixiang Wang Yonghua Yao Yu Gu Wei Wei |
| author_facet | Yongxin Zhou Haiyan Wang Dianyu Lu Tao Jiang Zhanpeng Huang Feixiang Wang Yonghua Yao Yu Gu Wei Wei |
| author_sort | Yongxin Zhou |
| collection | DOAJ |
| description | Abstract Background The ARISCAT score, a prospectively developed generic classification for postoperative pulmonary complications (PPCs), has shown excellent predictive performance in general surgery. However, there is no reliable classification instrument for PPCs prediciton in thoracic surgery. Objective This study aimed to develop and validate a novel nomogram for estimating the risk of pulmonary complications in older patients (≥ 65 years) within 30 days after NCTS. Methods A nomogram was developed using predefined candidate predictors of 30-day PPCs. It was fitted with least absolute shrinkage and selection operator and logistic regression methods. Internal validation was performed using a bootstrap-resampling approach, while external validation used an independent, temporally separated cohort. The model’s performance was assessed based on its discriminative potential (area under the receiver operating characteristic curve [AUC]), predictive ability (calibration plots), and clinical utility (net benefit). Results In the development (n = 1449) and validation (n = 449) cohorts, 34.9% and 31.4% of patients, respectively, developed pulmonary complications 30 days post-surgery. The final nomogram incorporated eight predictors (age, surgical approach, desaturation of < 92% for more than 2 min, duration of surgery, smoking status, FEV1/FVC%, respiratory infection in the last 30 days, and neoadjuvant chemotherapy). The nomogram showed excellent discrimination (AUC = 0.866, 95% confidence interval [CI], 0.846–0.885), calibration (Hosmer- Lemeshow test, P = 0.97) and overall performance (Brier score = 0.014) in the development cohort. Similar results were observed in the external validation cohort (AUC = 0.825, 95% CI, 0.786–0.864). A decision curve analysis indicated that the nomogram offers a positive net benefit compared with the ARISCAT and LAS VEGAS scores. Conclusions This novel nomogram can reliably identify older patients with a high risk for pulmonary complications within 30 days after NCTS. Trial registration ChiCTR2100051170. |
| format | Article |
| id | doaj-art-82c4e211c1134f0fbd1a612dfd9d9414 |
| institution | DOAJ |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj-art-82c4e211c1134f0fbd1a612dfd9d94142025-08-20T03:01:23ZengBMCBMC Geriatrics1471-23182025-03-0125111110.1186/s12877-025-05791-2Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort studyYongxin Zhou0Haiyan Wang1Dianyu Lu2Tao Jiang3Zhanpeng Huang4Feixiang Wang5Yonghua Yao6Yu Gu7Wei Wei8Department of Anesthesiology, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of Anesthesiology, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical UniversityDepartment of Anesthesiology, The University of Hong Kong - Shenzhen HospitalDepartment of Anesthesiology, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical UniversityDepartment of Thoracic Surgery, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical UniversityDepartment of Anesthesiology, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical UniversityDepartment of Anesthesiology, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical UniversityDepartment of Anesthesiology, Guangzhou Institute of Cancer Research, the Affiliated Cancer Hospital, Guangzhou Medical UniversityAbstract Background The ARISCAT score, a prospectively developed generic classification for postoperative pulmonary complications (PPCs), has shown excellent predictive performance in general surgery. However, there is no reliable classification instrument for PPCs prediciton in thoracic surgery. Objective This study aimed to develop and validate a novel nomogram for estimating the risk of pulmonary complications in older patients (≥ 65 years) within 30 days after NCTS. Methods A nomogram was developed using predefined candidate predictors of 30-day PPCs. It was fitted with least absolute shrinkage and selection operator and logistic regression methods. Internal validation was performed using a bootstrap-resampling approach, while external validation used an independent, temporally separated cohort. The model’s performance was assessed based on its discriminative potential (area under the receiver operating characteristic curve [AUC]), predictive ability (calibration plots), and clinical utility (net benefit). Results In the development (n = 1449) and validation (n = 449) cohorts, 34.9% and 31.4% of patients, respectively, developed pulmonary complications 30 days post-surgery. The final nomogram incorporated eight predictors (age, surgical approach, desaturation of < 92% for more than 2 min, duration of surgery, smoking status, FEV1/FVC%, respiratory infection in the last 30 days, and neoadjuvant chemotherapy). The nomogram showed excellent discrimination (AUC = 0.866, 95% confidence interval [CI], 0.846–0.885), calibration (Hosmer- Lemeshow test, P = 0.97) and overall performance (Brier score = 0.014) in the development cohort. Similar results were observed in the external validation cohort (AUC = 0.825, 95% CI, 0.786–0.864). A decision curve analysis indicated that the nomogram offers a positive net benefit compared with the ARISCAT and LAS VEGAS scores. Conclusions This novel nomogram can reliably identify older patients with a high risk for pulmonary complications within 30 days after NCTS. Trial registration ChiCTR2100051170.https://doi.org/10.1186/s12877-025-05791-2Older patientsNoncardiac thoracic surgeryPostoperative pulmonary complicationsPrediction |
| spellingShingle | Yongxin Zhou Haiyan Wang Dianyu Lu Tao Jiang Zhanpeng Huang Feixiang Wang Yonghua Yao Yu Gu Wei Wei Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort study BMC Geriatrics Older patients Noncardiac thoracic surgery Postoperative pulmonary complications Prediction |
| title | Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort study |
| title_full | Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort study |
| title_fullStr | Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort study |
| title_full_unstemmed | Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort study |
| title_short | Development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery: a prospective, bicentric cohort study |
| title_sort | development and validation of a nomogram for predicting postoperative pulmonary complications in older patients undergoing noncardiac thoracic surgery a prospective bicentric cohort study |
| topic | Older patients Noncardiac thoracic surgery Postoperative pulmonary complications Prediction |
| url | https://doi.org/10.1186/s12877-025-05791-2 |
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