Risk-scoring system predicting need for hospital-specific interventional care after peroral endoscopic myotomy

IF 5 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2024-09-02 DOI:10.1111/den.14909

Hirofumi Abe, Shinwa Tanaka, Hiroya Sakaguchi, Chise Ueda, Hitomi Hori, Tatsuya Nakai, Tetsuya Yoshizaki, Fumiaki Kawara, Takashi Toyonaga, Masato Kinoshita, Satoshi Urakami, Shinya Hoki, Hiroshi Tanabe, Yuzo Kodama

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引用次数: 0

Abstract

Objectives

Early identification of patients needing hospital-specific interventional care (HIC) following endoscopic treatment is valuable for optimizing postoperative hospital stays. We aimed to develop and validate a risk-scoring system for predicting HIC in patients who underwent peroral endoscopic myotomy (POEM).

Methods

This study included patients with esophageal motility disorders who underwent POEM at our hospital between April 2015 and March 2023. HIC was defined as any of the following situations: fasting for gastrointestinal rest to manage adverse events (AEs); intravenous administration of medications such as antibiotics and blood transfusion; endoscopic, radiologic, and surgical interventions; intensive care unit management; or other life-threatening events. A risk-scoring system for predicting HIC after postoperative day (POD) 1 was developed using multivariable logistic regression and was internally validated using bootstrapping and decision curve analysis.

Results

Of the 589 patients, 50 (8.5%) experienced HIC after POD1. Risk scores were assigned for four factors as follows: age (0 points for <70 years, 1 point for 70–79 years, 2 points for ≥80 years), preoperative prognostic nutritional index (0 points for >45, 1 point for 40–45, 4 points for <40), postoperative surgical site AEs on second-look endoscopy (7 points), and postoperative pneumonia on chest radiography (6 points). The discriminative ability (concordance statistics, 0.85; 95% confidence interval, 0.78–0.91) and calibration (slope 1.00; 0.74–1.28) were satisfactory. The decision curve analysis demonstrated its clinical usefulness.

Conclusion

This risk-scoring system can predict the HIC after POD1 and provide useful information for determining discharge.

查看原文本刊更多论文

预测口腔内窥镜肌切开术后医院介入治疗需求的风险评分系统。

目的：内镜治疗后需要住院介入治疗（HIC）的患者的早期识别对于优化术后住院时间非常重要。我们旨在开发并验证一套风险评分系统，用于预测口腔内镜下肌切开术（POEM）患者的 HIC：本研究纳入了2015年4月至2023年3月期间在我院接受POEM手术的食管运动障碍患者。HIC定义为以下任何一种情况：禁食以休息胃肠道以控制不良事件（AE）；静脉给药，如抗生素和输血；内窥镜、放射学和外科干预；重症监护室管理；或其他危及生命的事件。采用多变量逻辑回归法开发了一套用于预测术后第1天（POD）后HIC的风险评分系统，并通过引导和决策曲线分析进行了内部验证：在 589 名患者中，有 50 人（8.5%）在 POD1 后出现 HIC。该风险评分系统可预测 POD1 后的 HIC，并为决定出院提供有用信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.