PROGNOSTIC MODEL OF POSTOPERATIVE ADHESIVE INTESTINAL OBSRUCTION RISK IN CHILDREN
M Melnychenko1, A Kvashnina1, V Sytnikova1
1The Odessa National Medical University, Ukraine.
Insights
This study developed a prognostic model to predict postoperative adhesive intestinal obstruction in children. Key risk factors include leukopenia, connective tissue dysplasia, and surgery duration, enabling better treatment strategies.
Area of Science:
- Pediatric Surgery
- Clinical Prognostics
- Biostatistics
Background:
- Postoperative adhesive intestinal obstruction (PAIO) is a significant complication in pediatric surgery.
- Accurate prediction of PAIO risk is crucial for optimizing treatment strategies and patient outcomes.
- Existing models may not fully capture the multifactorial nature of PAIO in pediatric patients.
Purpose of the Study:
- To develop and validate a prognostic model for predicting the risk of PAIO in children.
- To identify key clinical and anamnestic factors associated with PAIO development after abdominal surgery.
- To utilize multivariate statistical methods for robust risk assessment.
Main Methods:
- Retrospective analysis of 119 children with acute inflammatory abdominal conditions.
- Application of binary logistic regression for predictive model development.
- Pearson's chi-squared test (χ2) to determine the significance of clinical and anamnestic signs.
- Receiver Operating Characteristic (ROC) analysis for model validation (AUC = 0.796).
Main Results:
- Identified significant predictors of PAIO: leukopenia at hospitalization (p=0.033), pronounced stigmatization with connective tissue dysplasia (p=0.013), and duration of surgery (p=0.0002).
- Developed a logistic regression-based prognostic model with high predictive accuracy (sensitivity 77%, specificity 72%).
- The model demonstrated a "very good" performance as assessed by ROC analysis.
Conclusions:
- The developed prognostic model effectively predicts the risk of PAIO in pediatric patients.
- Clinical application allows for informed decisions regarding surgical extent and optimized treatment strategies.
- This tool aids in improving care at all stages for children at risk of PAIO.
Abstract:
Objective - to develop a prognostic model of the postoperative adhesive intestinal obstruction risk in children by the use of multivariate statistics.; To create a model for the prediction of the postoperative adhesive intestinal obstruction by using the method of binary logistic regression, a retrospective analysis of the features of the acute inflammatory disease of the abdominal cavity organs and treatment strategy in 119 children.; The level of significance of clinical and anamnestic signs in children with appendicular peritonitis and the postoperative adhesive intestinal obstruction was determined using Pearson's test χ2. The main factors (leukopenia at hospitalization) (p=0.033) pronounced stigmatization with signs of connective tissue dysplasia (p=0.013) and duration of surgery (p=0.0002) were highlighted, which indicate the postoperative adhesive intestinal obstruction risk. The logistic regression method was used to create a prognostic model for calculating the postoperative adhesive intestinal obstruction risk, which was assessed as "very good" by ROC analysis (test sensitivity - 77%; specificity - 72%): AUC = 0.796.; The application of the proposed prognostic model of the postoperative adhesive intestinal obstruction risk in children with acute inflammatory diseases of the abdominal organs allows to make decision as for the extent of surgery and optimization of treatment strategy at all stages of rendering care.
