Clinical Research
Preoperative prediction model of anastomotic leakage after colorectal surgery
Zuohong Shang, Zaixing Wang, Jianxin Zhang, Dandan Ma, Zhenyu Lin, Weidong Jin
Published 2019-11-08
Cite as Chin J Exp Surg, 2019, 36(11): 2085-2089. DOI: 10.3760/cma.j.issn.1001-9030.2019.11.049
Abstract
ObjectiveTo analyze the preoperative risk factors of anastomotic leakage after colorectal surgery, construct a preoperative prediction model of anastomotic leakage after colorectal surgery, evaluate the probability of anastomotic leakage after surgery, and guide clinical decision-making.
MethodsFrom January 1, 2007 to December 31, 2016, 1 340 patients who underwent colorectal surgery and primary anastomosis in the Central Theater Command General Hospital of the Chinese People’s Liberation Army (formerly Wuhan General Hospital of Guangzhou Military Region) were collected. The risk factors of anastomotic leakage were analyzed by R-3.5.2. The forecasting model of contour map was drawn by RMS software package in R software.
ResultsThere are 123 cases of anastomotic leakage occurred in this study. The incidence of anastomotic leakage was 9.18% (123/1 340). Preoperative body mass index (BMI) was larger (Z=2.128, P<0.05), nutritional risk screening 2002 (NRS 2002 score) was larger (Z=10.617, P<0.05), lesion location in rectum (Z=4.069, P<0.05) and no nutritional support before operation (Z=2.144, P<0.05) were independent risk factors for anastomotic leakage. According to the results of multivariate logistic regression analysis, a contour map model of anastomotic leakage after colorectal surgery was constructed. According to the scale above the contour map corresponding to each risk factor, the single score of the factor can be obtained. The total score can be obtained by adding each single score, and the corresponding probability of anastomotic leakage can be obtained from the total score down. The area under the ROC curve was used to evaluate the predictive ability of the risk factors and the contour map prediction model. The area under the curve (AUC) > 0.75 indicated that the model had good predictive ability. The AUC for predicting anastomotic leakage after colorectal surgery is 0.86, which has good predictive performance.
ConclusionLarge BMI, high NRS2002 score, no nutritional support at the lesion site in rectum and before operation are independent risk factors for anastomotic leakage. The constructed contour map prediction model is helpful to predict the probability of anastomotic leakage after operation.
Key words:
Colorectal; Anastomotic leakage; Risk factors; Prediction model
Contributor Information
Zuohong Shang
Medical College of Wuhan University of Science and Technology, Wuhan 430065, China
Zaixing Wang
Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan 430070, China
Jianxin Zhang
Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan 430070, China
Dandan Ma
Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan 430070, China
Zhenyu Lin
Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan 430070, China
Weidong Jin
Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan 430070, China
