A New Nomogram-Based Prediction Model for Postoperative Outcome after Sigmoid Resection for Diverticular Disease
Abstract
:1. Introduction
2. Materials and Methods
2.1. Outcome of Interest
2.2. Statistical Analysis
3. Results
3.1. Patient Characteristics and Operative Data
3.2. Postoperative Outcome
3.3. Factors Associated with Occurrence of Morbidities and Prolonged Hospital Stay
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All Patients n = 282 | |
---|---|
Age (median ± SD) | 59.0 ± 13.35 |
Female/Male ratio (n; %) | 146/136 (51.77/48.23) |
BMI (kg/m2) [median ± SD] | 26.57 ± 5.59 |
ASA classification (n; %) | |
1 | 35 (12.41) |
2 | 118(41.84) |
3 | 74 (26.24) |
4 | 10 (3.55) |
NA | 45 (15.96) |
Comorbidities (n; %) | |
Diabetes | 20 (7.09) |
Arterial hypertension | 135 (47.87) |
Chronic renal insufficiency | 32 (11.35) |
Immunosuppression | 40 (14.18) |
Preoperative laboratory data | |
CRP (mg/dL) [median ± SD] | 3.75 ± 10.07 |
Leucocytes (×1000/µL) [median ± SD] | 10.20 ± 5.53 |
Hemoglobin (g/dl) [median ± SD] | 13.50 ± 2.16 |
Thrombocytes (×1000/µL) [median ± SD] | 264.0 ± 115.88 |
Number of episodes (n; %) | |
1 | 159 (56.38) |
2 | 51 (18.09) |
3 | 52 (18.44) |
≥4 | 20 (7.09) |
Modified Hinchey classification (n; %) | |
0 | 8 (2.84) |
IA * | 62 (21.99) |
IB | 105 (37.23) |
II | 27 (9.57) |
III | 69 (24.47) |
IV | 11 (3.90) |
Complicated current episode (n; %) | 216 (76.60) |
Emergency intervention (n; %) | 106 (37.59) |
Percutaneous abscess drainage (n; %) | 17 (6.03) |
Failure initial medical therapy (n; %) | 28 (9.93) |
Emergency surgery (n; %) | 96 (34.04) |
Duration current episode to surgery (days) [median ± SD] | 9.0 ± 31.79 |
All Patients n = 282 | |
---|---|
Primary laparoscopic (n; %) | 140 (49.65) |
Primary open (n; %) | 142 (50.35) |
Conversion to open procedure (n; %) | 29/140 (20.71) |
Hartmann’s resection (n; %) | 82 (29.08) |
Primary anastomosis without ostomy (n; %) | 174 (61.70) |
Primary anastomosis with protective ostomy (n; %) | 26 (9.22) |
Operative time (min) [median ± SD] | 245.0 ± 82.86 |
All Patients n = 282 | |
---|---|
Overall postoperative morbidity (n; %) | 116 (41.13) |
Surgical complications (n; %) | |
Wound infection | 89 (31.56) |
Burst abdomen | 15 (5.32) |
Anastomotic leak * | 10 (5.75) |
Anastomotic stenosis | 0 (0) |
Ileus (mechanic/paralytic) | 15 (5.32) |
Intra-abdominal abscess | 2 (0.71) |
Remote GI leak | 6 (2.13) |
Medical complications (n; %) | |
Sepsis | 12 (4.26) |
Pneumonia | 6 (2.13) |
Renal failure | 10 (3.55) |
Cardiovascular events | 9 (3.19) |
Clavien–Dindo Classification (n; %) | |
0 | 166 (58.87) |
I | 10 (3.55) |
IIa | 35 (12.41) |
IIb | 23 (8.16) |
IIIa | 30 (10.64) |
IIIb | 6 (2.13) |
IV | 2 (0.71) |
V | 10 (3.55) |
Re-operation (n; %) | 43 (15.25) |
Hospital stay (days) [median ± SD] | 11.0 ± 15.81 |
No Postoperative Morbidity n = 166 | Postoperative Morbidity n = 116 | p-Value | |
---|---|---|---|
Female/Male ratio | 81/85 (48.80/51.20) | 65/51 (56.03/43.97) | 0.275 |
Age (years) [median ± SD] | 56.0 ± 12.81 | 61.5 ± 13.47 | <0.0001 |
BMI (kg/m²) [median ± SD] | 26.87 ± 5.45 | 26.45 ± 5.81 | 0.382 |
Diabetes (n; %) | 7 (4.22) | 13 (11.21) | 0.032 |
Arterial hypertension (n; %) | 66 (39.76) | 69 (59.48) | 0.001 |
Chronic renal insufficiency (n; %) | 15 (9.04) | 17 (14.66) | 0.181 |
ASA classification (n; %) | <0.0001 | ||
1 | 28 (16.87) | 7 (6.03) | |
2 | 79 (47.59) | 39 (33.62) | |
3 | 33 (19.88) | 41 (35.34) | |
4 | 3 (1.81) | 7 (6.03) | |
Immunosuppression (n; %) | 15 (9.04) | 25 (21.55) | <0.0001 |
Preoperative laboratory data | |||
Leucocytes (1000/µL) [median ± SD] | 9.9 ± 5.69 | 10.55 ± 5.3 | 0.899 |
CRP (mg/dl) [median ± SD] | 2.75 ± 9.52 | 5.4 ± 10.75 | 0.062 |
Hemoglobin (g/dl) [median ± SD] | 14.1 ± 2.1 | 13.05 ± 2.13 | <0.0001 |
Thrombocytes (1000/µL) [median ± SD] | 259.0 ± 125.98 | 269.5 ± 99.9 | 0.221 |
Number of episodes (n; %) | 0.326 | ||
1 versus > 1 | 85/81 (51.20/48.80) | 74/42 (63.79/36.21) | 0.038 |
Modified Hinchey classification (n; %) | 0.084 | ||
0 | 4 (2.41) | 4 (3.45) | |
IA | 44 (26.51) | 18 (15.52) | |
IB | 66 (39.76) | 39 (33.62) | |
II | 13 (7.83) | 14 (12.07) | |
III | 34 (20.48) | 35 (30.17) | |
IV | 5 (3.01) | 6 (5.17) | |
Complicated current episode (n; %) | 120 (72.29) | 96 (82.76) | 0.045 |
Emergency intervention (n; %) | 52 (31.33) | 54 (46.55) | 0.012 |
Percutaneous abscess drainage (n; %) | 9 (5.42) | 8 (6.90) | 0.62 |
Failure of initial medical therapy (n; %) | 12 (7.23) | 16 (13.79) | 0.104 |
Emergency surgery (n; %) | 45 (27.11) | 51 (43.97) | 0.004 |
Duration: current episode to surgery (days) [median ± SD] | 10.0 ± 36.55 | 7.0 ± 21.71 | 0.009 |
Primary surgical approach (n; %) | <0.0001 | ||
Laparoscopic | 102 (61.45) | 38 (32.76) | |
Open | 64 (38.55) | 78 (67.24) | |
Transection approach (n; %) | <0.0001 | ||
Hartmann’s resection | 37 (22.29) | 45 (38.79) | |
Primary anastomosis without ostomy | 118 (71.08) | 56 (48.28) | |
Primary anastomosis with protective ostomy | 11 (6.63) | 15 (12.93) | |
Operative time (min) [median ± SD] | 250.0 ± 82.51 | 237.5 ± 83.62 | 0.339 |
Selected Variables | OR | 95% CI | p-Value |
---|---|---|---|
Leucocytes | 0.961 | 0.913–1.012 | 0.105 |
Hemoglobin | 0.873 | 0.768–0.991 | 0.042 |
Diabetes | 0.491 | ||
No | Reference | ||
Yes | 2.495 | 0.858–7.253 | |
ASA classification | 0.040 | ||
1 | Reference | ||
2 | 1.520 | 0.626–3.688 | |
3 | 2.503 | 0.942–6.650 | |
4 | 7.200 | 1.441–35.975 | |
Duration: current episode to surgery | 0.991 | 0.981–1.002 | 0.116 |
Primary surgical approach | 0.014 | ||
Laparoscopic | Reference | ||
Open | 2.897 | 1.431–5.862 | |
Operative time | 1.003 | 1.0–1.007 | 0.049 |
Total Patients n = 282 | Hospital Stay (days) [Median ± SD] | p-Value | |
---|---|---|---|
Sex (n; %) | 0.252 | ||
Male | 136 (48.23) | 11.0 ± 18.5 | |
Female | 146 (51.77) | 12.0 ± 12.89 | |
Diabetes (n; %) | 0.019 | ||
Yes | 20 (7.09) | 15.5 ± 13.05 | |
No | 262 (92.91) | 11.0 ± 15.58 | |
Arterial hypertension (n; %) | <0.0001 | ||
Yes | 135 (47.87) | 12.0 ± 19.04 | |
No | 147 (52.13) | 10.0 ± 10.19 | |
Chronic renal insufficiency (n; %) | 0.014 | ||
Yes | 32 (11.35) | 14.0 ± 28.8 | |
No | 250 (88.65) | 11.0 ± 13.12 | |
ASA classification (n; %) | <0.0001 | ||
1 | 35 (12.41) | 8.0 ± 3.33 | |
2 | 118 (41.84) | 10.5 ± 11.21 | |
3 | 74 (26.24) | 14.0 ± 20.33 | |
4 | 10 (3.55) | 19.5 ± 29.66 | |
NA | 45 (15.96) | NA | |
Immunosuppression (n; %) | <0.0001 | ||
Yes | 40 (14.18) | 14.5 ± 30.06 | |
No | 242 (85.82) | 11.0 ± 11.16 | |
Number of episodes (n; %) | <0.0001 | ||
1 | 159 (56.38) | 13.0 ± 15.1 | |
>1 | 123 (43.62) | 10.0 ± 16.6 | |
Modified Hinchey classification (n; %) | 0.001 | ||
0 | 8 (2.84) | 9.5 ± 8.86 | |
IA | 62 (21.99) | 9.0 ± 6.36 | |
IB | 105 (37.23) | 10.0 ± 12.99 | |
II | 27 (9.57) | 11.0 ± 10.02 | |
III | 69 (24.47) | 14.0 ± 24.28 | |
IV | 11 (3.90) | 13.0 ± 14.29 | |
Complicated current episode (n; %) | 0.003 | ||
Yes | 216 (76.60) | 12.0 ± 17.42 | |
No | 66 (23.40) | 9.0 ± 6.71 | |
Emergency intervention (n; %) | <0.0001 | ||
Yes | 106 (37.59) | 14.0 ± 22.02 | |
No | 176 (62.41) | 10.0 ± 8.63 | |
Percutaneous abscess drainage (n; %) | 0.007 | ||
Yes | 17 (6.03) | 16.0 ± 21.12 | |
No | 265 (93.97) | 11.0 ± 15.33 | |
Failure of initial medical therapy (n; %) | 0.004 | ||
Yes | 28 (9.93) | 17.0 ± 13.03 | |
No | 254 (90.07) | 11.0 ± 16.04 | |
Emergency surgery (n; %) | <0.0001 | ||
Yes | 96 (34.04) | 14.0 ± 21.69 | |
No | 186 (65.96) | 10.0 ± 10.55 | |
Primary surgical approach (n; %) | <0.0001 | ||
Laparoscopic | 140 (49.65) | 9.0 ± 9.8 | |
Open | 142 (50.35) | 14.0 ± 19.28 | |
Transection approach (n; %) | <0.0001 | ||
Hartmann’s resection | 82 (29.08) | 14.5 ± 23.15 | |
Primary anastomosis without ostomy | 174 (61.70) | 10.0 ± 9.35 | |
Primary anastomosis with protective ostomy | 26 (9.22) | 15.5 ± 13.79 |
Selected Variables | Coefficient (B) | SE | p-Value |
---|---|---|---|
Hemoglobin | −1.152 | 0.485 | 0.018 |
ASA classification | 3.610 | 1.154 | 0.002 |
1 | Reference | ||
2 | 1.308 | 2.731 | 0.632 |
3 | 3.546 | 3.388 | 0.296 |
4 | 11.887 | 5.111 | 0.021 |
Immunosuppression | 8.646 | 3.336 | 0.010 |
Emergency intervention | 10.689 | 4.693 | 0.024 |
Operative time | 0.031 | 0.010 | 0.010 |
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Vaghiri, S.; Krieg, S.; Prassas, D.; Loosen, S.H.; Roderburg, C.; Luedde, T.; Knoefel, W.T.; Krieg, A. A New Nomogram-Based Prediction Model for Postoperative Outcome after Sigmoid Resection for Diverticular Disease. Medicina 2023, 59, 1083. https://doi.org/10.3390/medicina59061083
Vaghiri S, Krieg S, Prassas D, Loosen SH, Roderburg C, Luedde T, Knoefel WT, Krieg A. A New Nomogram-Based Prediction Model for Postoperative Outcome after Sigmoid Resection for Diverticular Disease. Medicina. 2023; 59(6):1083. https://doi.org/10.3390/medicina59061083
Chicago/Turabian StyleVaghiri, Sascha, Sarah Krieg, Dimitrios Prassas, Sven Heiko Loosen, Christoph Roderburg, Tom Luedde, Wolfram Trudo Knoefel, and Andreas Krieg. 2023. "A New Nomogram-Based Prediction Model for Postoperative Outcome after Sigmoid Resection for Diverticular Disease" Medicina 59, no. 6: 1083. https://doi.org/10.3390/medicina59061083