Analysis of risk factor and establishment of prediction modeling for infectious complications after radical gastrectomy for gastric cancer:a retrospective cohort study
Objective To investigate the risk factors affecting the occurrence of infectious complications after radical gastrectomy for gastric cancer,and to establish a risk prediction Nomogram model.Methods The clinicopathologic data of 429 primary gastric cancer patients who underwent radical resection for gastric cancer at the Second Department of General Surgery of Shaanxi Provincial People's Hospital between January 2018 and December 2020 were retrospectively collected to explore the influencing factors of infectious complications using multivariate logistic regression analyses,and to construct a prediction model based on the results of the multivariate analysis,and then to further validate the differentiation,consistency,and clinical utility of the model.Results Of the 429 patients,infectious complications occurred in 86 cases(20.05％),including 53 cases(12.35％)of pulmonary infections,16 cases(3.73％)of abdominal infections,7 cases(1.63％)of incision infections,and 10 cases(2.33％)of urinary tract infections.The results of multivariate logistic analysis showed that low prognostic nutritional index[OR=0.951,95％CI(0.905,0.999),P=0.044],long surgery time[OR=1.274,95％CI(1.069,1.518),P=0.007],American Society of Anesthesiologists physical status classification(ASA)grade Ⅲ-Ⅳ[OR=9.607,95％CI(4.484,20.584),P＜0.001]and alcohol use[OR=3.116,95％CI(1.696,5.726),P＜0.001]were independent risk factors for the occurrence of infectious complications,and a Nomogram model was established based on these factors,with an area under the ROC of 0.802[95％CI(0.746,0.858)];the calibration curves showed that the probability of occurrence of infectious complications after radical gastrectomy predicted by the Nomogram was in good agreement with the actual results;the decision curve analysis showed that the Nomogram model could obtain clinical benefits in a wide range of thresholds and had good practicality.Conclusions Clinicians need to pay attention to the perioperative management of gastric cancer patients,fully assess the patients'own conditions through the prediction model established by prognostic nutritional index,surgery time,ASA grade and alcohol use,and take targeted interventions for the patients with higher risks,in order to reduce the risk of postoperative infectious complications.
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