Development and internal validation of a nomogram to predict postoperative atrial fibrillation in elderly patients with lung cancer.

BACKGROUND

The elderly are at high risk of developing postoperative atrial fibrillation (POAF) after lung resection, which is more likely to trigger serious complications such as heart failure, myocardial infarction, pulmonary embolism, and ischemic stroke, seriously affecting the recovery and prognosis of patients. This study aimed to develop and validate a nomogram for predicting POAF in elderly lung cancer patients.

METHODS

We retrospectively analyzed the medical records of 960 elderly patients undergoing thoracoscopic lung cancer surgery at Zhoushan Hospital from January 2022 to December 2023. Patients were divided into the POAF group and the non-POAF group. The least absolute shrinkage and selection operator (LASSO) identified univariate and multivariate logistic regression predictors. A nomogram was constructed using the selected variables, with internal validation performed via 500 bootstrap repetitions. Model accuracy was evaluated using calibration curves and the Hosmer-Lemeshow goodness-of-fit test (HL test), while predictive performance was assessed using the area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA) was conducted to assess predictive performance.

RESULTS

POAF incidence was 8.65% in the observation period. The nomogram included age [odds ratio (OR) 1.086; 95% confidence intervals (CI): 1.041-1.132], respiratory illness (OR 2.545, 95% CI: 1.234-5.247), non-hypertensive cardiovascular diseases (OR 2.212, 95% CI: 1.300-3.764), pulmonary lobectomy (OR 1.776, 95% CI: 1.047-3.013), anti-infection treatment (OR 1.657, 95% CI: 0.963-2.850), lymph node dissection (OR 2.181, 95% CI: 1.241-3.833) and drainage duration (OR 1.083, 95% CI: 1.010-1.161). The AUC value of the predictive model and the internal validation was 0.782 (0.734-0.830) and 0.782 (0.734-0.835), respectively. The calibration curves and result of the HL test (P=0.50) showed satisfactory consistency, and DCA demonstrated good clinical utility.

CONCLUSIONS

This nomogram exhibits good predictive performance and applicability, assisting clinicians in POAF prevention and management for elderly lung cancer patients.