结直肠术后手术部位感染临床预测模型的建立和验证  

Establishment and validation of a predictive clinical model for postoperative surgical site infection in patients with colorectal surgery

作　　者：阳怡羽 张旭飞 朱建伟[2] 王培戈[3] 刘雯静[4] 吴秀文 任建安 Yang Yiyu;Zhang Xufei;Zhu Jianwei;Wang Peige;Liu Wenjing;Wu Xiuwen;Ren Jian'an(Research Institute of General Surgery,Jinling Hospital,the Affiliated Second Clinical Hospital,Medical School of Southeast University,Nanjing 210002,China;Department of General Surgery,the Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Emergency Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]东南大学医学院附属第二临床医院(东部战区总医院)全军普通外科研究所,南京210002 [2]南通大学附属医院普通外科,南通226001 [3]青岛大学附属医院急诊外科,青岛266000 [4]中国医学科学院北京协和医学院、北京协和医院普通外科,北京100730

出　　处：《中华胃肠外科杂志》2023年第9期837-846,共10页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省重点研发计划(BE2022823);江苏省医学创新中心(CXZX202217)。

摘　　要：目的探讨结直肠术后手术部位感染(SSI)的危险因素,并建立及验证风险预测模型列线图。方法采用观察性研究的方法,从国家手术部位感染监测网中,回顾性收集国内56家医院2021年3月1日至2022年2月28日期间接受结直肠手术治疗并≥16岁的6527例患者数据资料,术后SSI发生率为2.3%(149/6527)。按7∶3的比例将6527例患者随机分为建模队列(4568例)和验证队列(1959例),两组数据集之间的差异无统计学意义(均P>0.05)。影响SSI发生的单因素分析采用t检验、Mann-WhitneyU检验或χ^(2)检验法;多因素分析先后采用二元logistic回归建立初步模型以及经由Lasso分析筛选变量后建立优化模型列线图,通过受试者工作特征(ROC)曲线、校准曲线和Hosmer-Lemeshow检验评估模型的区分度和校准度。曲线下面积(AUC)值>0.7则认为该模型区分度较好。采用Bootstrap法(重复自抽样1000次)对所构建的模型进行内部和外部验证,以评估所构建模型预测的准确性。结果影响SSI发生的多因素分析结果显示,慢性肝脏病史(OR=3.626,95%CI:1.297~10.137,P<0.001)和肾脏病史(OR=1.567,95%CI:1.042~2.357,P=0.038)、术前预防性使用抗生素(OR=1.564,95%CI:1.038~2.357,P=0.035)、手术类别为急诊手术(OR=1.432,95%CI:1.089~1.885,P=0.021)、开腹手术(OR=1.418,95%CI:1.045~1.924,P=0.042)、术前造口(OR=3.310,95%CI:1.542~7.105,P<0.001)、术后造口(OR=2.323,95%CI:1.537~8.134,P<0.001)、手术切口类别为Ⅱ级以上(OR=1.619,95%CI:1.097~2.375,P=0.014)以及总胆红素(OR=1.003,95%CI:0.994~1.012,P=0.238)、丙氨酸氨基转移酶(OR=1.006,95%CI:1.001~1.011,P=0.032)、血尿素氮(OR=1.003,95%CI:0.995~1.011,P=0.310)、血糖(OR=1.024,95%CI:1.005~1.043,P=0.027)、C反应蛋白(OR=1.007,95%CI:1.003~1.011,P<0.001)、切口长度(OR=1.042,95%CI:1.002~1.087,P=0.031)、手术持续时间(OR=1.003,95%CI:1.001~1.005,P=0.017)和术中出血量(OR=1.001,95%CI:1.000~1.002,P=0.045)每增加一个单位均为结直肠术后发生SObjective To investigate the risk factors of surgical site infection(SSI)after colorectal surgery,and to establish and validate a risk prediction model nomogram.Methods An observational study was conducted to retrospectively collect data of 6527 patients aged≥16 years who underwent colorectal surgery in 56 domestic hospitals from March 1,2021 to February 28,2022 from the national Surgical Site Infection Surveillance network.The incidence of SSI after surgery was 2.3%(149/6527).According to the ratio of 7:3,6527 patients were randomly divided into the modeling cohort(4568 cases)and the validation cohort(1959 cases),and there was no statistically significant difference between the two datasets(P>0.05).Univariate analysis was performed using t test/Mann-Whitney U test/χ^(2) test.Multivariate analysis was performed using binary logistic regression to establish a preliminary model and select variables using Lasso analysis to establish an optimized model nomogram.The discrimination and calibration of the model were evaluated by ROC curve,calibration curve,and Hosmer-Lemeshow test.AUC value>0.7 is considered a good discrimination of the model.The Bootstrap method(repeated self-sampling 1000 times)was used to verify the constructed model internally and externally to evaluate the accuracy of the constructed model.Results Multivariate analysis showed that history of chronic liver disease(OR=3.626,95%CI:1.297-10.137,P<0.001)and kidney disease(OR=1.567,95%CI:1.042-2.357,P=0.038),surgical antibiotic prophylaxis(OR=1.564,95%CI:1.038-2.357,P=0.035),and emergency surgery(OR=1.432,95%CI:1.089-1.885,P=0.021),open surgery(OR=1.418,95%CI:1.045-1.924,P=0.042),preoperative stoma(OR=3.310,95%CI:1.542-7.105,P<0.001),postoperative stoma(OR=2.323,95%CI:1.537-8.134,P<0.001),surgical incision type above grade II(OR=1.619,95%CI:1.097-2.375,P=0.014),and each unit increase in total bilirubin(OR=1.003,95%CI:-0.994-1.012,P=0.238),alanine aminotransferase(OR=1.006,95%CI:1.001-1.011,P=0.032),blood urea nitrogen(OR=1.003,95%CI:0.995-1.011,P=0.31

关 键 词：手术部位感染 结直肠手术 临床预测模型 列线图 

分 类 号：R656[医药卫生—外科学]