Analysis of risk factors for pulmonary embolism in elderly patients with localized renal cell carcinoma after laparoscopic par-tial nephrectomy
Objective To analyze the risk factors for pulmonary embolism(PE)in elderly patients with localized renal cancer(LRCC)after laparoscopic partial nephrectomy(RLPN).Methods 140 elderly LRCC patients who underwent RLPN in People's Hospital of Jiangsu Province from August 2022 to January 2024 were selected and divided into PE group(n=90)and non-PE group(n=50)according to whether PE occurred.The univariate and multivariate analysis were used to analyze the relevant risk factors for PE after RLPN,and a risk prediction model was established.Results Univariate analysis showed that BMI,chronic cardiovascular disease(hypertension,coronary heart disease),age,TC,surgery time,pneumoperitoneum time,postoperative bed rest time,and use of intermittent inflation pressure devices were all related to the occurrence of PE in LRCC patients after RLPN(P＜0.05).Logistic regression analysis showed that age ≥ 75 years,BMI,surgery time,pneumo-peritoneum pressure,postoperative bed rest time＞3 d,TC and the use of intermittent inflation pressure devices were all inde-pendent risk factors for PE in LRCC patients after RLPN(P＜0.05).The above 7 variables were included in the construction of a prediction model,and the final formula was:Logit(P)=-32.180+1.764 × age≥75 years+2.431 × BMI index(kg/m2)+0.095 × surgery time(min)+0.656 × pneumoperitoneum pressure(mmHg)+1.227 × postoperative bed rest time＞3 d+1.130 × TC(mmol/L)+1.093 × intermittent inflation pressure device(yes=0,no=1).AUC(the area under the ROC curve)for predicting the risk of PE in LRCC patients after RLPN was 0.787(95％CI:0.724-0.816),with a Youden index of 1.460 2,sensitivity of 0.64,and specificity of 0.62.The Hosmer-Lemeshow goodness of fit test showed that the model had good calibration(x2=8.093,P=0.421 7).Conclusion Elderly LRCC patients are prone to PE after RLPN,which may be related to age,BMI index,surgery time,surgical approach,pneumoperitoneum pressure,postoperative bed rest time,TC and the use of intermittent inflation pressure devices.
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