Development and validation of nomogram estimating post-surgery hospital stay of lung cancer patients: relevance for predictive, preventive, and personalized healthcare strategies
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In the era of fast track surgery, early and accurately estimating whether postoperative length of stay (p-LOS) will be prolonged after lung cancer surgery is very important, both for patient’s discharge planning and hospital bed management. Pulmonary function tests (PFTs) are very valuable routine examinations which should not be underutilized before lung cancer surgery. Thus, this study aimed to establish an accurate but simple prediction tool, based on PFTs, for achieving a personalized prediction of prolonged p-LOS in patients following lung resection.
The medical information of 1257 patients undergoing lung cancer surgery were retrospectively reviewed and served as the training set. p-LOS exceeding the third quartile value was considered prolonged. Using logistic regression analyses, potential predictors of prolonged p-LOS were identified among various preoperative factors containing PFTs and intraoperative factors. A nomogram was constructed and subjected to internal and external validation.
Five independent risk factors for prolonged p-LOS were identified, including older age, being male, and ratio of residual volume to total lung capacity (RV/TLC) ≥ 45.0% which is the only modifiable risk factor, more invasive surgical approach, and surgical type. The nomogram comprised of these five predictors exhibited sufficient predictive accuracy, with the area under the receiver operating characteristic curve (AUC) of 0.76 [95% confidence interval (CI) 0.73–0.79] in the internal validation. Also its predictive performance remained fine in the external validation, with the AUC of 0.70 (95% CI 0.60–0.79). The calibration curves showed satisfactory agreements between the model predicted probability and the actually observed probability.
Preoperative amelioration of RV/TLC may prevent lung cancer patients from unnecessary prolonged p-LOS. The integrated nomogram we developed could provide personalized risk prediction of prolonged p-LOS. This prediction tool may help patients perceive expected hospital stays and enable clinicians to achieve better bed management after lung cancer surgery.
KeywordsLength of stay Lung cancer Surgery Pulmonary function tests Prediction model Nomogram Advanced healthcare Individualized patient profile Hospitalization Economic burden Risk assessment Predictive preventive personalized medicine
EPMA European Association for Predictive, Preventive and Personalised Medicine
PPPM predictive, preventive and personalized medicine
p-LOS postoperative length of stay
PFTs pulmonary function tests
IC inspiratory capacity
FEV1 forced expiratory volume in 1 s
DLCO diffusion capacity for carbon monoxide
FVC forced vital capacity
COPD chronic obstructive pulmonary disease
RV/TLC ratio of residual volume to total lung capacity
VATS video-assisted thoracic surgery
SD standard deviation
IQR interquartile range
ROC receiver operating characteristic
AUC area under the receiver operating characteristic curve
OR odds ratio
CI confidence interval
Hu Xiang-Lin contributed to the study conception and design, data analysis, interpretation of the data, and drafting the manuscript. Yang Dong, Xu Song-Tao, Song Yuan-Lin, and Bai Chun-Xue contributed to the interpretation of the data and critical revision of the manuscript. Hu Xiang-Lin, Xu Song-Tao, Luo Jin-Long, Wang Xiao-Cen, Hou Dong-Ni, Zhang Xiao-Min, and Bao Chen contributed to the collection of the data. All authors read and approved the final manuscript.
This work was supported by State’s Key Project of Research and Development Plan in China (2017YFC1310602, 2017YFC1310600).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
Ethics approval and consent for participation
This study was approved by the Ethics Committee of Zhongshan Hospital, Fudan University, Shanghai, 200032, China. Informed consent for participation was obtained in this study. All procedures performed in the study involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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