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 56 279 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 30 days 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 65 years 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 model
CONCLUSIONS
The new Thoracoscore risk model has improved performance and good calibration, making it appropriate for use in current clinical practice.
the diameter remained constant.18 patients (60%) decrease in the volume and the diameter. 100% complete thrombus formation in early postoperative phase. 80% complete thrombus formation during the period of time mentioned above. 1 patient reintervention was resumed because of enoleak type IIb.1 patient BIF-Bypass implant was necessitating because of aortic stent graft occlusion. There were 4 death during the follow up. These included 3 patients who died because of myocardial infarction. 1 patient died (MI) within 30 days of operative intervention. Group two: 8 patients (26%) increase in the volume and the diameter of the aortic aneurysm sac. 8 patients (26%) the volume and the diameter remained constant.14 patients (48%) decrease in the volume and the diameter. 4 patients reintervention was resumed because of endoleak Typ IIb.2 patients open surgical were performed (binding) Conclusion: EVACST is feasible, leads to less reinterventions and has an impact on aneurysm rupture surrogate factors. The influence on aneurysm related mortality remains unclear at the early stage of the trial.
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