A risk prediction model of conversion to open surgery during laparoscopic splenectomy and esophagogastric devascularization
10.3760/cma.j.cn113855-20220224-00105
- VernacularTitle:腹腔镜脾切除联合贲门周围血管离断术中转开腹风险预测模型的构建
- Author:
Xiao CHEN
1
;
Jikai YIN
;
Dong WANG
;
Tao YANG
;
Li ZANG
;
Bo HUANG
;
Yanlong CAO
;
Jianguo LU
Author Information
1. 空军军医大学第二附属医院普通外科，西安 710038
- Keywords:
Hypertension, portal;
Splenectomy;
Laparoscopy;
Nomogram model
- From:
Chinese Journal of General Surgery
2022;37(6):404-409
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To establish a risk prediction model of conversion to open surgery during laparoscopic splenectomy and esophagogastric devascularization (LSED) and evaluate the impact of this conversion on patients' short-term prognosis.Methods:A total of 358 cirrhotic portal hypertension patients admitted to the Department of General Surgery , Second Affiliated Hospital, Air Force Military Medical University from Feb 2011 to Nov 2020 were retrospectively analyzed. All patients underwent attempted LSED. Univariate and least absolute shrinkage and selection operator (LASSO) Logistic regression were used to analyze the independent risk factors for conversion to laparotomy, and the R language was used to build a nomogram prediction model for conversion to laparotomy. The intraoperative and postoperative conditions of the two groups were compared.Results:A total of 358 patients were included in this study, of which 31(8.7%). patients were converted to open surgery. In univariate analysis, high MELD score, BMI ≥24 kg/m 2, history of upper abdominal surgery, red sign of the varicose, low platelet count and prolonged PT are risk factors for conversion . LASSO regression finally identified 5 factors: MELD, BMI, PLT, history of surgery, and red sign. In the nomogram prediction model the area under ROC curve was 0.831. The conversion led to longer operation time; increased blood loss; prolonged postoperative abdominal drainage , longer hospital stay, and increased perioperative complications ( t=-2.167, P=0.031; Z=-4.350, P<0.01; Z=-3.102, P=0.002; Z=-3.454, P=0.001; χ2=8.773, P=0.003). Conclusions:LASSO regression selected five indicators with greatest impact on intraoperative conversion: MELD, BMI, PLT, red sign, and previous history of abdominal surgery. The nomogram prediction model established has good prediction ability. Patients converted to open surgery had worse short-term outcomes.
