Development and Validation of an Online Nomogram Calculator to Predict Postoperative Pneumonia in Elderly Patients with Esophageal Cancer after Transthoracic Esophagectomy.

Abstract

Objectives: Postoperative pneumonia after esophagectomy is common, which may seriously burden elderly patients and aggravate their postoperative conditions. We sought to create an online nomogram calculator to predict postoperative pneumonia in elderly patients with esophageal cancer after transthoracic esophagectomy.

Design: Multivariable prediction models.

Setting: The Chinese People's Liberation Army (PLA) General Hospital.

Participants: Elderly patients (N = 607) underwent transthoracic esophagectomy between January 2012 and December 2019.

Interventions: Confirm the occurrence of postoperative pneumonia.

Measurements and main results: Univariable and multivariable logistic regression analyses were used to identify independent risk factors for postoperative pneumonia. A nomogram calculator was constructed according to the independent risk factors in the training cohort and then tested in the validation cohort. Multivariable logistic analysis showed that preoperative leukocyte count (p = 0.018), partial pressure of carbon dioxide (pCO₂) (p = 0.024), tumor location (p = 0.038), and operative duration (p < 0.001) were independent risk factors for postoperative pneumonia. We then developed a nomogram calculator using these four factors. The C-statistics of this nomogram in the training, validation, and entire cohorts were 0.680, 0.655, and 0.669, respectively. Risk analysis and decision curve analysis revealed that the nomogram provided good diagnostic power and net benefit.

Conclusion: We developed an online nomogram calculator that can predict the risk of postoperative pneumonia in elderly patients with esophageal cancer after transthoracic esophagectomy simply and conveniently.