240EXTERNAL VALIDATION OF THE FERGUSON PULMONARY RISK SCORE FOR PREDICTING MAJOR PULMONARY COMPLICATIONS AFTER OESOPHAGECTOMY

Objectives: Pulmonary complications remain a frequent cause of morbidity following oesophagectomy. Risk screening tools assist in patient stratification. Ferguson proposed a risk score to predict major pulmonary complications after oesophagectomy. Our objective was to validate this score externally. Methods: We analysed our institutional database for patients undergoing oesophagectomy from August 2009 to December 2012. We screened for variables necessary to calculate the risk score: FEV1, carbon monoxide diffusing capacity of the lung (DLCO), performance status and age. A total of 136 patients qualified for analysis. Outcome variables measured were major pulmonary complications, defined by reintubation for respiratory failure and pneumonia. The risk score was then calculated for each individual based on the model assigned, increasing points to variables. Incidence of major pulmonary events was assessed in the five risk groupings to assess the discriminative ability of the Ferguson score. Results: Major pulmonary complications occurred in 34.6% (47/136). Overall mortality was 5.9% (8/136). Patients were grouped into risk quintiles according to their Ferguson pulmonary risk score. Eight patients had a score of 0–2, 24 had a score 3–4, 49 had a score of 5–6, 29 with a score 7–8 and 26 with scores 9–14. The incidence of major pulmonary complications in these quintiles were 0%, 16.7%, 20.4%, 41.4% and 76.9 % (Fig. 1). The risk score system predicted pulmonary complications with an accuracy of 76.2% (P < 0.0001). Conclusion: The Ferguson pulmonary risk scoring system is a reliable instrument to be used preoperatively to differentiate those at higher risk for postoperative pulmonary complications after oesophagectomy. This data can assist in patient selection, education, informed consent, and guide postoperative management.