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Thoracoscore Risk Bands Substantially Underpredict In-Hospital Mortality After Thoracic Surgery: An External Validation Study in a Tertiary Referral Cohort Alif Alfiansyah; Gama Satria; Theodorus
Sriwijaya Journal of Surgery Vol. 9 No. 2 (2026): Sriwijaya Journal of Surgery
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i2.157

Abstract

Background: Thoracoscore is widely used to estimate preoperative mortality after general thoracic surgery, but its performance in Southeast Asian referral practice is uncertain. Objective: To evaluate the discrimination and calibration of the Thoracoscore risk-band table used routinely at an Indonesian tertiary centre. Methods: This retrospective cohort included 106 consecutive adults who underwent thoracic surgery at Dr Mohammad Hoesin General Hospital, Palembang, from January to December 2025. Seven of nine Thoracoscore domains were retrievable; therefore, the published points-to-risk band table, rather than the original logistic equation, was validated. Discrimination was assessed by permutation testing, calibration by observed-to-expected (O:E) ratios and within-band tests, and independent predictors by Firth-penalised logistic regression. Result: In-hospital mortality was 26.4% (28/106; 95% CI 19.0–35.5). Discrimination was absent (AUC 0.572, 95% CI 0.457–0.687; permutation p = 0.249). Calibration failed in every risk band: 28 deaths occurred compared with 2.88 expected (O:E 9.71, 95% CI 6.45–14.03), with a minimum O:E of 4.89 under the most favourable assignment of the two unrecorded domains. Malignancy was the only independent predictor (adjusted OR 4.12, 95% CI 1.51–13.10), but it did not remain significant after multiplicity adjustment (BH p = 0.061). Conclusion: The published Thoracoscore risk-band probabilities should not be used for individual consent at this centre. Recalibration reduces calibration error, but discrimination remains inadequate for reliable individual prediction.
Co-Authors Abda Arif Abrar Arbhiwa Tanguirsyaf Siregar Abu Bakar Lutfi Adenan Abadi Adenan Abadi admin Adnan Abadi Asnawi Adnan Abadi, Adnan Afifa Ramadanti Afladhanti, Putri Mahirah Agustina Br. Haloho Agustinus William Agustria Z. Saleh Alfajri Alif Alfiansyah Amarel, Fahma Alfarizqy Amir Fauzi Amirah Novaliani Anak Agung Gede Sugianthara Andriani, R.A. Linda Andriansyah, Yulius Andrina, Hana Angelica, Ellen Callista Anugrah Onie Aura Salsabilla Putri Awan Nurtjahyo Awan Nurtjahyo Azhar Susanto Azhari Azhari Azhari Rozali B, Firmansyah Benedictus Wicaksono Widodo Bernolian, N Bernolian, N Billy Sujatmiko D Saputra, Akbar N D.Y. Riyanto, D.Y. Dahler Bahrun Dandi, Dandi Daniatiek, Soneta Dastamuar, Shalita Debby Handayani Harahap Debby Handayati Harahap Devy Octarina Ditto Ruldifar Pribadi Doni Kurniawan Dwi Tantri Marylin Elvi Widiastuti Elza Iskandar, Elza Esterani, Esterani Evi Lusiana F, Amir Fahma Alfarizqy Amarel Fakhrudit, Emir Fauzit, Amir Fedriyansyah Fedriyansyah Feizal Faturahman Ferdi, Roni Ferry Yusrizal Firmansyah Basir Fita Asfianti Forbes, Darlin Gama Satria Gita Dwi Prasasty H.M. Nazir H.M. Nazir Hamzah, Haidar Ali Harahap, Debby Handayani Hartanto, Kristian S Heriansyah, Jhon Hidayat, Syarief Taufik Hilmawan, Bagus HM Nazir Hz Ika Kartika Ilham Taufan Ikramiawan Indira, Tissa Ismail Bastomi, Ismail Julius Anzar Kamaluddin Kamaluddin Kamaluddin, MT Kamaluddin, MT Khrismawan Khrismawan Kms Yusuf Effendi Kms Yusuf Effendy kurniati, nova Kusuma Harimin Leni Wijaya, Leni Lestari, Mayang Indah Lorenza, Geofanny Lutfi, Abu Bakar M Kamaluddin M. T. Kamaluddin Mahacakri, Eke P Mahadika, Febrinata Manan, Heriyadi Marta Hendry, Marta Martadiansyah, Abarham Maulani, H Maulani, H Maulani, Henni Mgs. Irsan Saleh, Mgs. Irsan Mgs. M. Irsan Saleh Muhammad Faisal Muhammad Hafidh Komar Muhammad Irsan Saleh Muhammad Rizqi Firyal Muhammad Totong Kamaluddin Mulawan Umar Mulawan Umar Muzakkie Muzakkie, Muzakkie Nadhif, Aufa Muhammad Nadira Rifda Utami Nita Parisa Nopriansyah Darwin Novianesari, Putri H Novianty, Novianty Nugraha, M Daffa Nugroho, Achmadi S Nur Qodir Nurul Islamy Nuswil Bernolian Nyiayu Fauziah Kurniawati Octarina, Bertha Oktariana, Desi Pangemanan, W T Pangemanan, W T Pangemanan, Wim T PATIYUS AGUSTIANSYAH, PATIYUS Puspita, Yusni Putri Mirani Putri, Safa Nabila Raden Ayu Kusuma Andini Rafiyandi Rafiyandi Rahima Rahima Renny Apliza Nasution Resiana Resiana Resti Resti Riani Erna, Riani Rika Saputri Rini Purnamasari Risa Vera Rizal Sanif Rizani Amran Rogatianus Bagus Pratignyo Romadhan, Muhammad Despriansyah Rose Mafiana Rostika Flora Rostika Flora Rusydi, Syakroni D Sabrina, Tia Sahab, Abdullah Saleh, Masagus Irsan Salim, Eddy M Salni Sari Octarina Piko Sastradinata, Irawan Shaleh, Agustria Z Silvana, Rista Silvia Triratna Siti Rusdiana Puspa Dewi Sonlimar mangunsong Stevanny, Bella Sudarto Sudarto Sujatmiko, Billy Sulbahri, Robby P. Suriani Rosida Sutomo Tanzil Syakirah, Fatimah Syarif Husin Syarif Husin Syarinta Adenina Tahany, Hanifah Tanzil, Sutomo Tindar, Mirzah Tissa Indira Tribowo, Anang Trijoso Permono Usman, Fatimah Vandy Ikra Veronita Veronita Veronita, Veronita Wahyu Pranata, Wahyu Pranata Weldy, Weldy Yohanes Febrianto Yulia Iriani, Yulia Yuliana Yuliana Yundari, Yundari Yuniza, Yuniza Yusuf, Kemas Zainal, Rizal Zanaria, Rima Zulkifli Zulkifli