Risk Quantification for Pulmonary Complications After Lung Cancer Surgery

Purpose. The purpose of this study was to identify the risk factors for postoperative pulmonary complications and to develop a scoring system to predict the surgical outcomes in lung cancer patients. Methods. Clinical data were collected from January 1990 to March 2007 for 1713 patients who underwent lung cancer surgery at Chiba University Hospital. Between January 1990 and December 2000, 1032 evaluation subjects' data were used to identify risk factors for postoperative pulmonary complications (PC). These factors were subclassified into grades to develop a scoring system to predict surgical outcomes. This scoring system was applied to 681 test patients between January 2001 and March 2007. Results. Postoperative PC were present in 115 (11.1%) evaluation subjects. Multivariate analyses revealed six risk factors associated with postoperative PC: male, advanced age, preoperative interstitial pneumonia, high smoking index, combined resection, and vascular and/or bronchial reconstruction. Each risk factor was scored from 0 to 2 or 3, based on the frequency of the PC. The sum of these scores provided a total risk index (TRI: Sekine score). There was a significant correlation between the frequency of PC and the TRI (R-2 = 0.957, P < 0.0001). Fifty-one of the test subjects had PC (7.5%). They also showed a significant correlation between the PC and TRI (R-2 = 0.946, P < 0.0001). Conclusion. The TRI was a valuable scoring system for predicting postoperative pulmonary complications.