Risk factors and predictive model construction for the occurrence of pelvic floor dysfunction after transvaginal total hysterectomy
Objective To investigate the risk factors for pelvic floor dysfunction(PFD)after transvaginal total hysterectomy and to construct a nomogram prediction model.Methods 139 patients who underwent transvaginal total hysterectomy in Wuhan Hanyang Hospital from January 2019 to December 2021 were selected,and according to the occurrence of PFD 12 months after surgery,the patients were divided into PFD group(n =41)and non-PFD group(n =98).The general data of the two groups were compared,and the indicators affecting the occurrence of PFD after transvaginal total hysterectomy were analyzed;the ROC curve analysis was performed by MedCalc software for the measures with statistically significant differences to explore their predictive value for the occurrence of PFD after transvaginal total hysterectomy;Logistic regression analysis was used to analyze the independent risk factors affecting PFD after vaginal hysterectomy;the nomogram prediction model for the occurrence of PFD after transvaginal total hysterectomy was constructed with the R language software 4.0"rms"package,and the calibration and decision curves were used to internally validate the nomogram prediction model and evaluate the clinical predictive efficacy.Results The differences between the two groups were statistically significant in terms of age,BMI,smoking,alcohol consumption,number of pregnancies,mode of delivery,and history of abortion(P<0.05).The AUC for age and BMI were 0.674 and 0.823,respectively,and the optimal cutoff values were 49 years old and 24.4 kg/m2,respectively.Age,BMI,alcohol consumption,frequency of pregnancy and delivery methods were independent risk factors for the occurrence of PFD after transvaginal total hysterectomy.The calibration curve of the nomogram prediction model was close to the original curve and the ideal curve with a C-index of 0.675(95%CI:0.633-0.732),and the model fit was good;the threshold of the nomogram prediction model was>0.19,which could provide a net clinical benefit,and the net clinical benefit was higher than that of age,BMI,alcohol consumption,number of pregnancies and mode of delivery in all cases.Conclusion In this study,a nomogram prediction model was constructed based on the independent risk factors of PFD after transvaginal hysterectomy,namely age,BMI,drinking,pregnancy and delivery mode,which had a good predictive value for the occurrence of PFD and helped clinical interventions for patients at high risk of PFD to reduce the incidence of PFD.
transvaginal total hysterectomypelvic floor dysfunctionalrisk factorsnomogrampredictive model
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