Construction and verification of intraoperative hypothermia risk early warning model for patients undergoing conversion to laparotomy from laparoscopic cholecystectomy for acute calculous cholecystitis
Construction and verification of intraoperative hypothermia risk early warning model for patients undergoing conversion to laparotomy from laparoscopic cholecystectomy for acute calculous cholecystitis
Objective:To investigate the influencing factors of intraoperative hypothermia in patients with acute calculous cho-lecystitis undergoing laparoscopic cholecystectomy(LC)converted to laparotomy,and to construct and validate a risk prediction model based on independent risk factors.Methods:Retrospectively,114 patients with acute calculous cholecystitis who underwent LC conver-ted to laparotomy from Jan.2019 to Dec.2023 were selected as the modeling group,and an additional 76 patients were included as the validation group in the ratio of 6∶4.According to whether hypothermia occurred in the modeling group,the patients were divided into occurrence group and non-occurrence group.The independent risk factors were obtained by univariate analysis and multivariate logistic regression analysis,and a risk prediction model was constructed.R software was used to draw corresponding nomogram.Receiver operat-ing characteristic curve and calibration curve were used to test the prediction efficiency.The data of the validation set were used for external verification of the prediction efficacy of the model.Results:Of the 114 patients in the modeling group,hypothermia occurred in 30(occurrence group)and the other 84 did not experience hypothermia(non-occurrence group),with an incidence of 26.32％.Multi-variate logistic regression analysis showed that age,anesthesia method,surgical time,intraoperative fluid infusion volume,intraoperative irrigation fluid volume,intraoperative bleeding,and absence of active warming measures were independent risk factors for intraoperative hypothermia in patients undergoing LC converted to laparotomy for acute calculous cholecystitis(OR＞1,P＜0.05),and BMI was an independent protective factor(OR＜1,P＜0.05).The area under the curve of the risk prediction model based on the above independent influencing factors was 0.969,and the corresponding sensitivity and specificity were 93.9％and 91.7％,respectively.The calibration curve was close to the ideal curve,and the mean absolute error was 0.036.The area under the curve of the validation set was 0.970,the corresponding sensitivity and specificity were 94.7％and 91.2％,respectively,and the mean absolute error of the calibration curve was 0.058.Conclusions:The occurrence of intraoperative hypothermia in patients with acute calculous cholecystitis undergoing LC conver-ted to laparotomy is affected by age,body mass index,anesthesia mode,operative time,intraoperative rehydration volume,intraoperative irrigation volume,intraoperative hemorrhage volume,and active heat preservation measures.Risk prediction model constructed based on the above factors has good predictive efficacy,which can be used as a reference for predicting and intervening the occurrence of intra-operative hypothermia.
关键词
急性结石性胆囊炎/胆囊切除术,腹腔镜/中转开腹手术/低体温/预测模型
Key words
Acute calculous cholecystitis/Cholecystectomy,laparoscopic/Conversion to open surgery/Hypothermia/Prediction model
维普
万方数据