Predictive Value Of Modified POSSUM Scoring System In The Incidence Of Complications After Thoracoscopic Surgery In Patients With Lung Cancer

Object: The purpose of this study is to explore an improved method of POSSUM scoring system for thoracoscopic surgery in patients with lung cancer,and to discuss the clinical value of the modified POSSUM scoring system in predicting the incidence of postoperative complications.Methods: The clinical medicine records of 142 patients who underwent thoracoscopic lung cancer surgery in the Cardiothoracic Surgery Department of the First Affiliated Hospital of Shihezi University Medical College from January 2016 to December 2018 were collected,including preoperative physiological indicators and postoperative complications.The 34 patients with postoperative complications were assigned to the complication group,and the remaining 108 patients without postoperative complications were assigned to the non-complication group.Chi-square test was used to analyze the differences in various indicators between the two groups of patients.Logistic multivariate regression was used to screen out independent risk factors for postoperative complications and assign values to the risk factor indicators.Calculate the physiological score and operative severity score of the two groups of patients,take the physiological score and operative severity score as independent variables,and take postoperative complications as the dependent variable,and perform logistic regression analysis to obtain the modified POSSUM score equation.The modified POSSUM scoring system was used to analyze the prediction of postoperative complications,and its receiver operating characteristic curve(ROC)was plotted,and the area under the curve(AUC)of the two scoring system were compared.Results: A total of 34 patients had 47 cases of postoperative complications.Logistic multivariate regression showed that age,cardiovascular system signs,respiratory system signs,heart rate,surgical resection range,bleeding volume,BMI,FEV1%,and operation duration had statistical significant for postoperative complications(P <0.05).The equation of modified POSSUM scoring system is ? [R /(1-R)] =-5.894+(0.128 × physiological score)+(0.123 × operative severity score),where R is the incidence of postoperative complications,and it's ROC curve cutoff value is 0.2257.The sensitivity of the modified POSSUM system is 70.6%,the specificity is 66.7%,and the AUC is 0.710 ± 0.0513 [95% CI(0.628-0.783)].The AUC of the standard POSSUM scoring system is 0.649 ± 0.0550 [95% CI(0.565-0.727)].The difference of AUC between the two system was statistically significant(P <0.05).Conclusion: The modified POSSUM scoring system was superior to the standard POSSUM scoring system in predicting the incidence of postoperative complications in patients with lung cancer who underwent thoracoscopic surgery.The new prediction equation is ? [R /(1-R)] =-5.894+(0.128 ×physiological score)+(0.123 × operative severity score).When R > 22.57%,the possibility of postoperative complications is higher in patients,and we should take comprehensive clinical interventions to reduce the risk of surgery.