A Prediction Model for Prolonged Length of Stay After Cholecystectomy in Patients with Chronic Acalculous...

This study aimed to inform a basis for nursing intervention through investigating the clinical risk factors for prolonged length of stay (PLOS) in patients with chronic acalculous cholecystitis (CAC) after cholecystectomy and constructing a predictive model.

The prediction model for the PLOS in patients with CAC after cholecystectomy was developed using a retrospective research design. Data were extracted from Medical Information Mart for Intensive Care IV. Logistic regression was used to explore the influencing factors of PLOS using the interpolated data. A variety of statistical methods, such as receiver operating characteristic (ROC) analysis, decision curve analysis, 5-fold cross-validation method, and SHapley Additive exPlanations, were conducted to assess, validate, and interpret the prediction model.

The study included 204 patients with CAC who underwent cholecystectomy. The average age was 60.23 ± 14.30 years, with 65.2% experiencing a PLOS. Multivariable logistic regression analysis showed that age (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.01-1.08), calcium (OR = 0.48, 95% CI: 0.24-0.93), ciprofloxacin (OR = 3.08, 95% CI: 1.14-9.91), fentanyl (OR = 4.08, 95% CI: 1.36-14.53), and mild liver disease (MLD) (OR = 0.30, 95% CI: 0.11-0.76) may be the influencing factors for PLOS. The prediction model based on the five variables demonstrated moderate discrimination capacity according to ROC and decision curve analysis. The ROC results based on the 5-fold cross-validation method revealed that the average area under the curve was 0.75 (95%CI: 0.67-0.83) in the training set, 0.71 (95%CI: 0.54-0.88) in the validation set, and 0.72 (95%CI: 0.53-0.90) in the test set. SHapley Additive exPlanations analysis identified age as the most influential factor, followed by calcium, fentanyl, ciprofloxacin, and MLD.

The prediction model, based on age, calcium, fentanyl, ciprofloxacin, and MLD, demonstrated moderate discrimination capacity in predictive PLOS in patients with CAC after cholecystectomy. These findings may support the identification of at-risk patients and inform early nursing interventions.