Construction and validation analysis of a risk prediction model for postoperative incision infection in patients with rectal cancer undergoing ileostomy reversal surgery
10.3760/cma.j.cn341190-20240808-01018
- VernacularTitle:直肠癌患者回肠造口还纳术后切口感染风险预测模型的构建及其验证分析
- Author:
Fang WANG
1
;
Xuemeng XIE
;
Fuman CAI
Author Information
1. 温州医科大学附属第一医院结直肠肛门外科，温州 325000
- Publication Type:Journal Article
- Keywords:
Colorectal neoplasms;
Ileostomy;
Infection;
Diabetes mellitus;
Operative time;
Chemoradiotherapy, adjuvant
- From:
Chinese Journal of Primary Medicine and Pharmacy
2025;32(9):1320-1325
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To construct a risk prediction model for postoperative incision infection in patients with rectal cancer undergoing ileostomy reversal surgery and to validate this model.Methods:A retrospective study was conducted on 700 patients who underwent ileostomy at The First Affiliated Hospital of Wenzhou Medical University. The patients were randomly divided into a modeling group ( n = 490) and a validation group ( n = 210) in a 7:3 ratio. The incidence of incision infection was recorded, and logistic multiple regression analysis was performed on various factors that may affect incision infection. A predictive model was constructed, and the application value of the predictive model was assessed. Results:Based on the occurrence of postoperative incision infection, patients in the modeling group who underwent ileostomy reversal surgery were divided into an infection group ( n = 61) and a non-infection group ( n = 429). There were no statistically significant differences between the two groups in terms of sex, age, body mass index, history of smoking, history of hypertension, history of immune system diseases, tumor, node, and metastasis staging, history of abdominal surgery, preoperative albumin levels, intraoperative hypothermia, and intraoperative blood loss (all P > 0.05). However, the proportion of patients with a history of diabetes was higher in the infection group [27.87% (17/61)] compared with the non-infection group [5.59% (24/429)]. The proportion of patients with a surgical duration > 90 minutes was also higher in the infection group [70.49% (43/61)] compared with the non-infection group [49.88% (214/429)]. Additionally, the proportion of patients with postoperative subcutaneous drainage was lower in the infection group [16.39% (10/61)] than in the non-infection group [40.56% (174/429)]. The proportion of patients with a history of radiotherapy and chemotherapy was higher in the infection group [75.41% (46/61)] compared with the non-infection group [53.15% (228/429)]. The proportion of patients with peristomal dermatitis was higher in the infection group [31.15% (19/61)] than in the non-infection group [4.20% (18/429)]. All these differences were statistically significant ( χ2 = 34.56, 9.09, 13.30, 10.74, 51.78, all P < 0.05). A history of diabetes, postoperative subcutaneous drainage, surgical duration, a history of radiotherapy and chemotherapy, and peristomal dermatitis were included in the regression model (all P < 0.05). Among these, a history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy were identified as independent risk factors, while postoperative subcutaneous drainage was identified as a protective factor. The risk prediction model was constructed as follows: P = -3.791 + 2.594 × a history of diabetes + 1.839 × surgical duration - 2.261 × postoperative subcutaneous drainage + 2.673 × a history of radiotherapy and chemotherapy + 2.765 × peristomal dermatitis. The prediction of the nomogram model for the risk of incision infection after ileostomy reversal surgery in the modeling group showed an area under the receiver operating characteristic curve of 0.931 ( P < 0.001, 95% CI: 0.847-0.983), with a sensitivity of 83.41% and a specificity of 79.91%. The receiver operating characteristic curve results for the validation group indicated an area under the curve of 0.891 ( P < 0.001, 95% CI: 0.821-0.967), with a sensitivity of 75.00% and a specificity of 94.90%. Conclusions:A history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy are independent risk factors for incision infection after ileostomy reversal surgery, while postoperative subcutaneous drainage is a protective factor. Constructing a predictive model based on these factors shows good predictive value for the occurrence of incision infection after ileostomy reversal surgery and needs further clinical investigation.
