Individualised risk in patients undergoing lung volume reduction surgery (LVRS): The Glenfield BFG Score

Introduction: LVRS has been shown to be beneficial in patients with COPD but there is low uptake, partly due to perceived concerns of high operative mortality. We aimed to develop an individualised risk score after LVRS. Methods: This was a cohort study of patients undergoing LVRS. Factors independently predicting 90 day mortality and a risk prediction score were identified. Reliability of the score was tested using area under receiver operator characteristic curve (AUROC). Results: 237 LVRS procedures were performed. The multivariate analysis factors associated independently with death were; BMI <18.5 kg/m2(OR 2.83, p=0.059), FEV1<0.71L (OR 5.47, p=0.011) and TLCO<20% (OR 5.56, p=0.031). A risk score was calculated and a total score assigned. AUROC for the risk score was 0.80 and a better predictor than individual components (p<0.01). The score was stratified into three risk groups. 46% of patients were classified as low risk. Similar improvements in lung function and health status were seen in all groups. The score was introduced and tested in a further 71 patients. AUROC for 90 day mortality in this cohort was 0.84. Conclusion: It is possible to provide an individualised predictive risk score for LVRS, which may aid decision making for both clinicians and patients.