Risk Prediction of Unplanned Reoperation in Surgical Patients Based on Nomogram Model
Objectives This study aims to investigate the risk factors of unplanned reoperations and establish an early warning model to reduce the incidence of unplanned reoperations.Methods Information on 12,786 patients who underwent ≥2 surgeries during the same hospitalization period in a hospital from January 1,2019 to December 31,2022 was selected.According to the discharge standard of unplanned reoperations,289 cases of unplanned reoperation were selected as the research group,and 12 497 cases of planned reoperation were selected as the control group.Univariate and multivariate Logistic regression analyses were performed to identify the risk factors of unplanned reoperation.R software was used to build a nomogram model for predicting the occurrence of unplanned reoperation and verify the effect of the nomogram model in predicting the occurrence of unplanned reoperation.Results The incidence rate of unplanned reoperation after surgery was 0.17％(289/161,554).The results of univariate analysis showed that there were statistically significant differences in the patient age,malignant tumor,previous surgical method,previous surgical duration,previous chief surgeon title,anesthesia grade,surgical risk grade,incision grade,and previous surgical grade between the two groups(P＜0.05).The results of logistic regression analysis showed that the duration of the previous surgery,the presence of malignant tumors,anesthesia grade more than P3,two and three incisions,senior professional titles of the previous chief surgeon,third and fourth level surgeries,two and three surgical risk levels were independent risk factors for the occurrence of unplanned reoperation,while minimally invasive surgery was a protective factor(P＜0.05).The area under the ROC curve(AUC)for the risk of unplanned reoperations in the training group of the model was 0.879(95％CI=0.8762-0.8589),and the AUC for predicting the risk of DN in the validation group was 0.831(95％CI=0.7385-0.8489)based on the predictor variables.The Hosmer-Lemeshow calibration curve fit was good(P=0.892 for the training group;P=0.885 for the validation group).Conclusions The independent influencing factors of unplanned reoperation include the length of the patient's previous surgery,the presence of malignant tumors,anesthesia grade more than P3,two and three incisions,senior professional titles of the previous chief surgeon,third and fourth level surgeries,two and three surgical risk level,and minimally invasive surgery.The nomogram model constructed based on the above factors has good sensitivity and specificity and it has great significance for clinical medical staff to promptly identify high-risk patients and take effective intervention measures to reduce the occurrence of unplanned reoperation.
万方数据
维普
