Establishment And Application Of The General Thoraicic Surgical Difficulty Assessment System

Purpose:The purpose of this study is to build a quantized assessment indicator system for thoracic surgical difficulty, and apply it to the clinical practive to exam its applications.Method:1. We retrospectively studied the relationship between the demographic/surgical data of lung cancer patients and surgical time and perfusion rate, which are used as surrogate markers for surgical difficulty;2. We investigate the possible factors that may cause surgical difficulty by2rounds of conference survey, and build an index pool for surgical difficulty assessment. Then we conducted2rounds of Delphi survey to delete/add some particular indexes and weight those indexes. The thoracic surgical difficulty scale is finally established;3. The thoracic surgical difficulty scale was applied to the clinical practice to study its reliability, validity, and its application in the field of evaluating the surgical difficulty of different surgical types, and predicting surgical difficulty.Results:1.97lung cancer patients are studied in the retrospective study. The mean operation time is165min and the perfusion rate is11.8%. Diabetes(B=1.977, OR=7.196, p=0.080), VAS grading(B=1.190, OR=3.286, p=0.017) and VATS(B=1.194, OR=3.299, p=0.041) are independent risk factors of long operation time. Patient age(B=1.321, OR=3.747, p=0.006) and DLCO%predicted(B=-0.415, OR=0.661, p=0.088) are independent risk factor of intraoperative perfusion.2. According to the results of the conference surveys and Delphi surveys, we established the thoracic surgical difficulty assessment scale, which includes5primary indicators and16secondary indicators. The primary and secondary indicators are:the surgical decision making (ASA grading, surgical trauma, surgeon experiences), the working space (size, depth, source and adjacent), the dissecting plane (contents, tissue plane, vision and size), the rebuilding technique (complexity and extent) and the surgical tools (autologous materials, artificial biological materials and equipment).3.127thoracic surgeries are enrolled in the prospective study(89lung tumor surgeries,18esophageal tumors, and20mediastinal tumors, respectively), the mean difficulty score of the three groups are1.69,1.86and1.56, respectively. The Cronbach’s alpha coefficient and Spearman-Brown coefficient of the lung, esophageal, and mediastinal tumor surgeries are0.993、0.974(0.972-0.974) and0.989(0.987-9.989) respectively. In lung tumor and mediastinal tumor surgeries, the Spearman correlation coefficient rs between the difficulty score and surgical time, estimated blood loss and Visual Analog Scale(VAS) are:0.360and0.634,0.632and0.578,0.696and0.875, respectively(p<0.05). the difficulty scores are higher in the perfusion group than non-perfusion group, and iatrogenic injury group than non-iatrogenic injury group (p<0.05). However, in esophageal tumor surgeries, the difficulty score showed no relationship with these surrogate markers. In the pulmonary tumor surgeries, the surgical type, tumor pathology, tumor location and local adhesion may influence the surgical difficulty score.Conclusions:1. We successfully established the quantized Thoracic Surgical Difficulty Assessment Scale.2. the Thoracic Surgical Difficulty Assessment Scale reflected the pulmonary and mediastinal tumor surgical difficulty in multiple aspects and levels, and can be used as a comprehensive and objective assessment tool.