Establishment and verification of prediction model for adhesive ileus after laparoscopic appendectomy in patients with acute appendicitis
- VernacularTitle:急性阑尾炎患者腹腔镜阑尾切除术后发生粘连性肠梗阻预测模型的建立及验证
- Author:
Cong HE
1
;
Feng LI
1
;
Kuanheng ZHENG
1
Author Information
- Publication Type:Journal Article
- Keywords: acute appendicitis; laparoscopic appendectomy(LA); adhesive ileus; prediction model
- From: China Journal of Endoscopy 2025;31(8):18-25
- CountryChina
- Language:Chinese
- Abstract: Objective To explore the influencing factors of adhesive ileus after laparoscopic appendectomy(LA)in patients with acute appendicitis,then establish and verify its prediction model.Methods 100 cases of acute appendicitis treated by LA from January 2021 to January 2024 were retrospectively analyzed.According to the ratio of 7:3,the patients were randomly divided into the training group(70 cases)and the verification group(30 cases),and then the patients in the training group were divided into the occurrence group(12 cases)and the non-occurrence group(58 cases)according to whether adhesive ileus occurred during the follow-up for 6 months after LA.The difference of clinical data between the two groups was compared,and multivariate Logistic regression method was used to analyze the independent risk factors of adhesive ileus after LA.The nomogram prediction model was constructed,and the performance of the prediction model was evaluated by Bootstrap method,calibration curve,receiver operator characteristic curve(ROC curve)and decision curve.Results The results of multivariate Logistic regression model showed that the risk factors of postoperative adhesive ileus in patients with acute appendicitis after LA were the course of disease>24 h,preoperative albumin≤34 g/L,the number of LA operating tables for LA operators<60,the operation time>1 h,and the time of getting out of bed for the first time after operation>24 h were independent risk factors for adhesive ileus after LA operation(P<0.05).In the training set and verification set,the results of Bootstrap method and ROC curve showed that the prediction model had good discrimination,and the C indexes were 0.723(95%CI:0.642～0.875)and 0.706(95%CI:0.628～0.768)respectively.AUCs were 0.874(95%CI:0.625～0.924)and 0.867(95%CI:0.612～0.895)respectively.Goodness-of-fit test showed that the prediction model had good fitting effect(P>0.05).The calibration curves of training set and verification set were close to the ideal curve,and the prediction model had good accuracy.The decision curves of training set and verification set showed that the nomogram model could produce better clinical benefits when the threshold probability of high risk was 0.10～0.80 and 0.25～0.48 respectively,and the net benefit rate was greater than 0.Conclusion The occurrence of adhesive ileus after LA in patients with acute appendicitis is related to the course of disease,albumin level,operator experience,operation time and the first time to get out of bed after surgery.The nomogram model has good predictive performance.
