Nomogram for predicting severe abdominal adhesions prior to definitive surgery in patients with anastomotic fistula post-small intestine resection: a cohort study.

IF 12.5 2区 医学 Q1 SURGERY
Zheng Yao, Weiwei Shang, Fan Yang, Weiliang Tian, Guoping Zhao, Xin Xu, Risheng Zhao Md, Tao Tian, Wuhan Li, Ming Huang, Yunzhao Zhao, Qian Huang
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引用次数: 0

Abstract

Background: This study aimed to develop and validate a nomogram for predicting the presence of severe intra-abdominal adhesions before definitive surgery (DS) for anastomotic fistula following small intestine resection (SIR).

Methods: Patients were enrolled from January 2009 to October 2023 and were randomly divided (2:1) into development and validation cohorts. Predictors of severe adhesion were identified and integrated into a nomogram. The nomogram's performance was evaluated through calibration, discrimination, and clinical utility. Results: A total of 414 patients were included, with 276 in the development cohort and 138 in the validation cohort. Severe adhesion was diagnosed in 54 (13%) patients, including 37 (13.4%) in the development cohort and 17 (12.3%) in the validation cohort (p = 0.76). Five predictors were identified: Sequential Organ Failure Assessment (SOFA) score, duration of early-stage abdominal infection, preoperative albumin (Alb) < 35 g/L, visceral to subcutaneous fat area ratio, and preoperative C-reactive protein (CRP) > 10 mg/L. The nomogram demonstrated robust discrimination, with a Concordance Index (C-index) of 0.80 (95% CI 0.76-0.90) in internal validation, and was well-calibrated. In the validation cohort, the model maintained good discrimination (C-index = 0.79; 95% CI 0.67-0.94) and calibration. Decision curve analysis affirmed the nomogram's clinical utility.

Conclusion: This study introduces a practical nomogram for assessing the risk of severe abdominal adhesion prior to DS in patients undergoing surgery for anastomotic fistula after SIR.

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来源期刊
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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