Amar et al developed a clinical prediction rule for predicting pulmonary complications after thoracic surgery for a primary lung cancer. This can help to identify a patient who may require more aggressive management. The authors are from Memorial Sloan-Kettering Cancer Center in New York City.
Patient selection: thoracic surgery for primary lung cancer
Outcome: pulmonary complications (atelectasis, pneumonia, pulmonary embolism, respiratory failure, need for supplemental oxygen at hospital discharge)
Parameters:
(1) preoperative chemotherapy
(2) postoperative diffusion capacity of lung for carbon monoxide (DLco) as percent of predicted
predicted postoperative DLco =
= (preoperative DLco) * (1 - ((number of resected segments) / (total number of segments)))
where:
• A wedge biopsy is considered to be 1 segment.
• DLco is reported in mL CO per min per mm Hg.
postoperative DLco as percent of predicted =
= ((predicted) - (observed)) / (predicted) * 100%
|
Parameter
|
Finding
|
Points
|
|
preoperative chemotherapy
|
no
|
0
|
|
|
yes
|
2
|
|
postoperative DLco
|
|
ROUND((percent of predicted) / 5, 0)
|
total score =
= SUM(points for both parameters)
Interpretation:
• minimum score: 0
• maximum score: probably 19 or 20 (DLco could not be 0% of predicted)
• The higher the score the greater the risk.
|
Total Score
|
Risk Category
|
Percent
|
|
0 to 10
|
low
|
9%
|
|
11 to 13
|
intermediate
|
14%
|
|
>= 14
|
high
|
36%
|
