Journal
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Volume 62, Issue 3, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ejcts/ezac170
Keywords
Risk model; External validation; Morbidity; Mortality; Eurolung; Anatomic lung resection; Thoracic surgery; Generalization
Funding
- Spanish Society of Thoracic Surgery
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The external validation of Eurolung 1 and Eurolung 2 was conducted in a multicentre national database. Eurolung 1 showed suboptimal calibration and lower discrimination, while Eurolung 2 exhibited good calibration and higher discrimination. Therefore, Eurolung 2 seems to be applicable to other anatomic lung-resected patients, while Eurolung 1 lacks generalizability for new patients.
OBJECTIVES There is a wide variety of predictive models of postoperative risk, although some of them are specific to thoracic surgery, none of them is widely used. The European Society for Thoracic Surgery has recently updated its models of cardiopulmonary morbidity (Eurolung 1) and 30-day mortality (Eurolung 2) after anatomic lung resection. The aim of our work is to carry out the external validation of both models in a multicentre national database. METHODS External validation of Eurolung 1 and Eurolung 2 was evaluated through calibration (calibration plot, Brier score and Hosmer-Lemeshow test) and discrimination [area under receiver operating characteristic curves (AUC ROC)], on a national multicentre database of 2858 patients undergoing anatomic lung resection between 2016 and 2018. RESULTS For Eurolung 1, calibration plot showed suboptimal overlapping (slope = 0.921) and a Hosmer-Lemeshow test and Brier score of P = 0.353 and 0.104, respectively. In terms of discrimination, AUC ROC for Eurolung 1 was 0.653 (95% confidence interval, 0.623-0.684). In contrast, Eurolung 2 showed a good calibration (slope = 1.038) and a Hosmer-Lemeshow test and Brier score of P = 0.234 and 0.020, respectively. AUC ROC for Eurolung 2 was 0.760 (95% confidence interval, 0.701-0.819). CONCLUSIONS Thirty-day mortality score (Eurolung 2) seems to be transportable to other anatomic lung-resected patients. On the other hand, postoperative cardiopulmonary morbidity score (Eurolung 1) seems not to have sufficient generalizability for new patients.
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