Lack of Utility of Thoracoscore in Evaluating Fitness for Surgery in Lung Cancer.

BACKGROUND: The thoracic surgery scoring system (Thoracoscore) is a multivariate scoring system with nine parameters used for predicting inpatient mortality after thoracic surgery. In clinical practice, the value of the thoracoscore in evaluating the fitness of individual patients for surgery is not clear. OBJECTIVE: The study objective was to evaluate the performance of thoracoscore in evaluating fitness for surgery for lung cancer and compare it with cardiopulmonary exercise test (CPEX). METHODS: We retrospectively analysed data over a 2-year period from the CPEX database of patients referred for preoperative assessment prior to surgery for lung cancer. RESULTS: Twenty-two patients who had borderline lung function impairment had CPEX to assess fitness for surgery. Fifteen (68%) were deemed fit and went on to have thoracic surgery while 7 (32%) were considered high risk and were turned down. The predicted death rate based on thoracoscore for patients who had surgery was 3.5 ± 2.8 as compared to 3.4 ± 2.0 for patients who did not have surgery (p > 0.05). The mean peak VO2 (peak oxygen uptake during CPEX) among those who had surgery was significantly higher than those who did not have surgery (14.2 mL/kg/min versus 10.1 mL/kg/min). There was no correlation of thoracoscore with lung function parameters, duration of hospital stay and peak VO2. CONCLUSIONS: Our study showed that CPEX remains a standard and useful tool for functional assessment prior to lung cancer resection. There is no correlation between thoracoscore and either CPEX or pulmonary function parameters. Thoracoscore should not be used to assess fitness for surgery.

Clostridium difficile in cardiac surgery: risk factors and impact on postoperative outcome.

BACKGROUND: Clostridium difficile-associated diarrhea (CDAD) is a potentially preventable and often troublesome gastrointestinal complication after cardiac surgery. METHODS: A retrospective study was performed of 8,405 cardiac surgery patients at two institutions between January 1997 and August 2004. Preoperative cardiac risk factors, perioperative factors including blood product transfusion, antibiotic utilization, and postoperative morbidity and mortality were recorded. Univariate and multivariate analyses were performed comparing C. difficile patients with a control group matched by date of surgery and institution. RESULTS: Sixty-six of the 8,405 patients identified with toxin-positive CDAD produced an overall incidence of 0.79% (0.70% at institution A and 1.09% at institution B), with a peak overall incidence of 5.45% in June 2003. Independent prognostic factors for CDAD by multivariate analysis included advancing age (odds ratio [OR] 1.028, 95% confidence interval [CI]: 1.001 to 1.056; p = 0.034), female sex (OR 2.026, 95% CI: 1.102 to 3.722; p = 0.022), blood product transfusion (OR 3.277, 95% CI: 1.292 to 8.311; p = 0.006), and increasing cumulative days of antibiotic administration (OR 1.046, 95% CI: 1.014 to 1.080; p = 0.004). There were no differences in the proportion of fluoroquinolones, cephalosporins, or penicillin derivatives administered between groups. The diagnosis of CDAD was associated with a greater median length of mechanical ventilation (25 hours versus 12 hours, p < 0.001), longer intensive care unit stay (5 days versus 2 days, p < 0.001), and extended hospital stay (21 days versus 7 days, p < 0.001), with no difference in 30-day mortality (7.6% versus 9.5%, p = 0.80). CONCLUSIONS: Although the overall incidence of CDAD was low, alteration in transfusion practices and antibiotic utilization may impact the development of CDAD among cardiac surgical patients.