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Establishment and validation of a nomogram for predicting postoperative intestinal adhesion in children with acute
Dezhao Liu1,2, Yuchi Wang2, Liyun Sun1,2
1Graduate School, Changchun University of Chinese Medicine, Changchun, Jilin, 130000, China.
Insights
Delayed postoperative exhaust time (≥55 hours) significantly increases the risk of intestinal adhesion (IA) after pediatric appendectomy. Early restoration of intestinal function is crucial for preventing IA following appendicitis surgery.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Risk Assessment
Background:
- Intestinal adhesion (IA) is a common complication after appendectomy for acute appendicitis (AA) in children.
- Accurate risk factor evaluation is essential for preventing IA and improving patient outcomes.
Purpose of the Study:
- To identify and evaluate multiple indicators as risk factors for IA post-appendectomy in pediatric AA patients.
- To develop a predictive model for postoperative IA.
Main Methods:
- Retrospective study of 608 pediatric patients undergoing appendectomy.
- One-year follow-up for IA occurrence.
- Univariate and multivariate analyses, including Binary Logistic regression, to screen risk factors.
- Development and validation of a nomogram-based prediction model.
Main Results:
- Key risk factors identified: prolonged postoperative exhaust time (≥55 h, OR=14.483), elevated procalcitonin (PCT ≥0.9 µg/L, OR=8.683), longer surgical duration (≥100 min, OR=6.457), appendiceal perforation (OR=6.073), elevated C-reactive protein (CRP ≥65 mg/L, OR=3.424), and prolonged diagnostic score (DS ≥43 h, OR=3.903).
- The nomogram demonstrated high predictive efficiency with an area under the curve (AUC) of 0.960 in the training set and 0.957 in the test set.
- High sensitivity (0.898-0.864) and specificity (0.905-0.906) were achieved in both sets.
Conclusions:
- Postoperative exhaust time ≥55 hours is a significant risk factor for IA after pediatric appendectomy.
- Early recovery of intestinal peristalsis function is critical for preventing IA.
- The developed scoring model offers a novel and effective method for predicting postoperative IA.
Purpose:
This study aims to explore the value of multiple indicators in the evaluation of risk factors for intestinal adhesion (IA) after appendectomy in children with acute appendicitis (AA).
Methods:
A retrospective study was conducted on 608 patients who underwent appendectomy in the Department of Pediatric Surgery, Children's Medical Center of Jilin Province from January 2017 to April 2023, with a one-year follow-up period to record the occurrence of IA after appendectomy. Univariate and multivariate analysis were used to screen the risk factors of postoperative IA, and a prediction model was established to predict postoperative IA.
Results:
There were 527 patients in the non-IA group and 81 patients in the IA group. Binary Logistic regression was used to determine the strength of correlation with postoperative intestinal adhesion. The risk factors identified were as follows: DS ≥ 43 h (OR = 3.903, 5points), CRP ≥ 65 mg/L (OR = 3.424, 4.5points), PCT ≥ 0.9 µg/L (OR = 8.683, 8points), Surgical duration ≥ 100 min (OR = 6.457, 7points), Appendiceal perforation (OR = 6.073, 6.5points), Postoperative exhaust time ≥ 55 h (OR = 14.483, 10points). After test, the nomogram drawn based on binary logistic regression can obtain good prediction efficiency. In the training set, the area under the curve was 0.960, the sensitivity was 0.898, and the specificity was 0.905. In the test set, the area under the curve was 0.957, the sensitivity was 0.864, and the specificity was 0.906.
Conclusion:
Postoperative exhaust time ≥ 55 h has a high risk of IA after appendicitis surgery in children. Early recovery of intestinal peristalsis function is essential. This scoring model is a novel and promising method for predicting postoperative IA.
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