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J Thorac Cardiovasc Surg 2007;133:325-332
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

The Thoracic Surgery Scoring System (Thoracoscore): Risk model for in-hospital death in 15,183 patients requiring thoracic surgery

Pierre Emmanuel Falcoz, MD, PhDa,*, Massimo Conti, MDb, Laurent Brouchet, MDc, Sidney Chocron, MD, PhDa, Marc Puyraveau, BScd, Mariette Mercier, MD, PhDe, Joseph Philippe Etievent, MDa, Marcel Dahan, MDc

a Department of Thoracic and Cardiovascular Surgery, Jean-Minjoz Hospital, Besançon
b Department of Thoracic Surgery, Calmette Hospital, Lille
c Department of Thoracic Surgery, Larrey Hospital, Toulouse
d Clinical and Biological Research Center, Saint-Jacques Hospital, Besançon
e Department of Biostatistics and Epidemiology, Medical School, Besançon, France.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29–May 3, 2006.

Received for publication May 17, 2006; revisions received August 27, 2006; accepted for publication September 29, 2006.

* Address for reprints: Pierre Emmanuel Falcoz, MD, Department of Thoracic and Cardiovascular Surgery, Hôpital Jean-Minjoz, Boulevard Fleming, 25000 Besançon, France. (Email: pierre-emmanuel.falcoz{at}wanadoo.fr).

OBJECTIVE: This study was undertaken to determine factors associated with in-hospital mortality among patients after general thoracic surgery and to construct a risk model.

METHODS: Data from a nationally representative thoracic surgery database were collected prospectively between June 2002 and July 2005. Logistic regression analysis was used to predict the risk of in-hospital death. A risk model was developed with a training set of data (two thirds of patients) and validated on an independent test set (one third of patients). Model fit was assessed by the Hosmer–Lemeshow test; predictive accuracy was assessed by the c-index.

RESULTS: Of the 15,183 original patients, 338 (2.2%) died during the same hospital admission. Within the data used to develop the model, these factors were found to be significantly associated with the occurrence of in-hospital death in a multivariate analysis: age, sex, dyspnea score, American Society of Anesthesiologists score, performance status classification, priority of surgery, diagnosis group, procedure class, and comorbid disease. The model was reliable (Hosmer–Lemeshow test 3.22; P = .92) and accurate, with a c-index of 0.85 (95% confidence interval 0.83-0.87) for the training set and 0.86 (95% confidence interval 0.83-0.89) for the test set of data. The correlation between the expected and observed number of deaths was 0.99.

CONCLUSIONS: The validated multivariate model Thoracoscore, described in this report for risk of in-hospital death among adult patients after general thoracic surgery was developed with national data, uses only 9 variables, and has good performance characteristics. It appears to be a valid clinical tool for predicting the risk of death.

Abbreviations and Acronyms ASA = American Society of Anesthesiologists; CI = confidence interval; OR = odds ratio; PS = performance status




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