胃癌和结直肠癌术后器官/腔隙感染的风险因素分析与预测模型的建立

Analysis of risk factors and construction of prediction models for organ/space surgical site infection in gastric and colorectal cancer

摘要:

目的 探讨胃癌和结直肠癌手术后手术部位感染中器官/腔隙感染发生率及危险因素, 旨在为患者构建一个简单、有效的风险预测模型。 方法 回顾性收集2018年1月—2022年10月某院进行根治性手术治疗的356例胃癌和305例结直肠癌患者的临床资料, 通过单变量及多变量logistic回归分析确定器官/腔隙SSI的独立风险因素, 并构建列线图模型。采用一致性指数(C-index)与校准曲线评价模型对胃肠癌术后器官/腔隙SSI的预测能力。 结果 胃癌与结直肠癌患者术后器官/腔隙SSI发生率分别为8.4%(30/356)、9.5%(29/305)。与非SSI患者相比, 器官/腔隙SSI患者住院日数明显延长(P < 0.001)。多因素分析结果显示, 男性(OR=5.203, 95%CI: 1.167~23.193)、术前ASA Ⅲ级(OR=5.078, 95%CI: 2.047~12.598)、联合脏器切除(OR=3.479, 95%CI: 1.261~9.546)及术中失血量(OR=3.629, 95%CI: 1.577~8.350)是胃癌术后器官/腔隙SSI的独立风险因素(均P＜0.05);ASA分级(OR=3.128, 95%CI: 1.334~7.337)、联合脏器切除(OR=3.442, 95%CI: 1.292~9.168)及手术时间(OR=3.091, 95%CI: 1.367~6.991)是结直肠癌器官/腔隙SSI独立风险因素(均P＜0.05)。基于以上风险因素分别构建预测胃癌、结直肠癌术后器官/腔隙SSI的列线图模型, C-index分别为0.808(95%CI: 0.722~0.894)、0.763(95%CI: 0.674~0.852)。校准曲线表明模型预测曲线与理想参考线之间具有良好一致性。 结论 列线图模型对胃癌和结直肠癌术后器官/腔隙SSI具有良好预测能力, 可为临床医生识别高风险SSI个体提供一种简单、有效的工具。

Abstract:

Objective To evaluate the incidence and risk factors for organ/space surgical site infection (SSI) after gastric and colorectal cancer surgery, and construct simple and effective risk prediction models for patients. Methods Clinical data were retrospectively collected from 356 patients with gastric cancer and 305 patients with colorectal cancer who underwent radical surgery in a hospital from January 2018 to October 2022. Independent risk factors for organ/space SSI were identified by univariate and multivariate logistic regression analysis, and nomogram models were constructed. The concordance index (C-index) and calibration curve were used to evaluate the predictive performance of the gastric and colorectal cancer models. Results The incidences of postoperative organ/space SSI in gastric and colorectal cancer patients were 8.4% (30/356) and 9.5% (29/305), respectively. Patients with organ/space SSI had a longer hospital stay than those without SSI (P < 0.001). Multivariate analysis showed that male (OR=5.203, 95%CI: 1.167-23.193), pre-operative ASA grade Ⅲ(OR=5.078, 95%CI: 2.047-12.598), combined organ resection (OR=3.479, 95%CI: 1.261-9.546) and intraoperative blood loss (OR=3.629, 95%CI: 1.577-8.350) were independent risk factors for organ/space SSI after gastric cancer surgery (all P < 0.05). ASA grade (OR=3.128, 95%CI: 1.334-7.337), combined organ resection (OR=3.442, 95%CI: 1.292-9.168) and duration of operation (OR=3.091, 95%CI: 1.367-6.991) were independent risk factors for organ/space SSI after colorectal cancer surgery (all P < 0.05). Based on these risk factors, nomogram models for predicting organ/space SSI after gastric and colorectal cancer surgery were developed, with C-indexes of 0.808 (95%CI: 0.722-0.894) and 0.763 (95%CI: 0.674-0.852), respectively. The calibration curves indicated good consistency between the predicted curves and the ideal reference lines. Conclusion The nomogram models have an excellent prediction performance for organ/space SSI in gastric and colorectal cancer patients underwent radical resection, and provide a simple and effective tool for clinicians to identify high-risk individuals with SSI.