Wang Deyong,Jiang Li,Li Congjun,et al.Risk factors of wound infection after laparoscopic acute appendicitis in children and potency of a nomogram prediction model[J].Journal of Clinical Pediatric Surgery,2022,21(08):769-773.[doi:10.3760/cma.j.cn101785-202108066-012]
小儿急性阑尾炎腹腔镜手术后切口感染危险因素分析及列线图预测模型的构建
- Title:
- Risk factors of wound infection after laparoscopic acute appendicitis in children and potency of a nomogram prediction model
- 关键词:
- 阑尾炎/病理生理学; 腹腔镜检查; 外科伤口感染/并发症; 外科伤口感染/病因学; 危险因素; 预测; 儿童
- Keywords:
- Appendicitis/PP; Laparoscopy; Surgical Wound Infection/CO; Surgical Wound Infection/ET; Risk Factors; Forecasting; Child
- 摘要:
- 目的 探讨影响小儿急性阑尾炎腹腔镜手术后切口感染的危险因素,构建预测术后切口感染的列线图模型,并评估模型的区分度和一致性。方法 选取2016年1月至2021年3月在安徽医科大学附属亳州医院小儿外科行腹腔镜下阑尾切除术的480例患儿作为研究对象,其中手术后发生切口感染65例(65/480,13.54%),未发生切口感染415例(415/480,86.46%)。收集所有患儿年龄、病理、手术时间、术前体温、阑尾穿孔以及是否留置腹腔引流等临床资料,采用单因素及多因素Logistic回归分析筛选影响小儿腹腔镜急性阑尾炎术后切口感染的危险因素;采用R软件构建预测术后切口感染的列线图模型,并使用受试者操作特性曲线(receiver operating characteristic curve,ROC)及校准曲线验证列线图模型的区分度和一致性。结果 小儿腹腔镜急性阑尾炎术后切口感染发生率为13.54%(65/480)。单因素分析显示,年龄、病程、手术操作时间、术前发热、阑尾穿孔、留置腹腔引流是小儿腹腔镜急性阑尾炎术后切口感染的影响因素(P<0.05);多因素Logistic回归分析结果显示,病程>24 h、手术操作时间>60 min、阑尾穿孔、留置腹腔引流是小儿急性阑尾炎腹腔镜手术后切口感染的危险因素(P<0.05);构建的列线图预测模型具有较好的区分度(ROC曲线下面积为0.816,95%CI:0.716~0.871)和一致性(Hosmer-Lemeshow拟合优度检验值=8.661,P=0.372)。结论 本研究构建的预测小儿急性阑尾炎腹腔镜手术后切口感染发生风险的列线图模型,具有较好的区分度和一致性。
- Abstract:
- Objective To explore the risk factors of wound infection after laparoscopic acute appendicitis (AA) in children,construct a nomogram model to predict postoperative incision infection and evaluate the distinction and consistency of the model.Methods From January 2016 to March 2021,480 children undergoing appendectomy were selected as study subjects.They were assigned into two groups of surgical incision infection post-operation (n=65) and surgical incision non-infection post-operation (n=415).The relevant clinical data were collected.Single factor and multivariate Logistic regression analyses were employed for screening the risk factors of influencing wound infection.R software was utilized for constructing a nomogram model to predict postoperative incision infection and receiver operating characteristic (ROC) and calibration curves for verifying the discrimination and consistency of nomogram model.Results The incidence of wound infection was 13.54%(65/480).Univariate analysis indicated that age,course of disease,operative duration,preoperative fever,appendiceal perforation and indwelling abdominal drainage were all influencing factors of wound infection (P<0.05);multivariate Logistic regression analysis revealed that disease course >24h,operative duration >60 min,appendiceal perforation and indwelling abdominal drainage were the risk factors for incision infection;nomogram prediction model offered excellent discrimination (area under the ROC curve was 0.816,95%CI=0.716-0.871) and consistency (Hosmer-Lemeshow goodness of fit test showed=8.661,P=0.372).Conclusion With excellent discrimination and consistency,the above nomogram model may predict the risk of wound infection after laparoscopic AA in children.
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备注/Memo
收稿日期:2021-8-27。
基金项目:2021年亳州市重点研发计划(bzzc2021024);2020年亳州市人民医院院级科研项目(By202029)
通讯作者:罗贤茂,Email:heynumber007@163.com