Nomogram for prediction of severe postoperative complications in elective hepato-pancreato-biliary surgery after COVID-19 breakthrough infection:A large multicenter study  

作　　者：Yun Yang Zheng Dang Liang Tang Peng Lu Shang Ma Jin Hou Ze-Ya Pan Wan Yee Lau Wei-Ping Zhou 

机构地区：[1]The Third Department of Hepatic Surgery,Eastern Hepatobiliary Surgery Hospital,Naval Medical University,Shanghai 200438,China [2]Department of Hepatobiliary Surgery,The 940th Hospital of Joint Logistics Support Force of Chinese PLA,Lanzhou 730050,China [3]Department of Pancreatic-Biliary Surgery,Shanghai Changzheng Hospital,Naval Medical University,Shanghai 200003,China [4]Department of Hepatobiliary Surgery,Hainan Hospital of Chinese PLA General Hospital,Sanya 572000,China [5]National Key Laboratory of Medical Immunology&Institute of Immunology,Naval Medical University,Shanghai 200433,China [6]Faculty of Medicine,the Chinese University of Hong Kong,Shatin,New Territories Hong Kong SAR,China [7]Key Laboratory of Signaling Regulation and Targeting Therapy of Liver Cancer(Ministry of Education),Naval Medical University,Shanghai 200438,China [8]Shanghai Key Laboratory of Hepatobiliary Tumor Biology,Eastern Hepatobiliary Surgery Hospital,Shanghai 200438,China

出　　处：《Hepatobiliary & Pancreatic Diseases International》2025年第2期147-156,共10页国际肝胆胰疾病杂志(英文版)

基　　金：supported by grants from the Science Fund for Creative Research Groups of the National Natural Science Founda-tion of China(81521091 and 82073031);the National Natural Sci-ence Foundation of China(92269204);Clinical Research Plan of SHDC(SHDC2020CR5007 and SHDC22020213)。

摘　　要：Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validatio

关 键 词：NOMOGRAM Severe postoperative complications Hepato-pancreato-biliary surgery COVID-19 Breakthrough infection 

分 类 号：R656[医药卫生—外科学]