Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
Br J Surg. 2019 Nov;106(12):1676-1684. doi: 10.1002/bjs.11235. Epub 2019 Jul 17.
Postoperative ileus (POI) is a significant complication after loop ileostomy closure given both its frequency and impact on the patient. The purpose of this study was to develop and externally validate a prediction model for POI after loop ileostomy closure.
The model was developed and validated according to the TRIPOD checklist for prediction model development and validation. The development cohort included consecutive patients who underwent loop ileostomy closure in two teaching hospitals in Montreal, Canada. Candidate variables considered for inclusion in the model were chosen a priori based on subject knowledge. The final prediction model, which modelled the 30-day cumulative incidence of POI using logistic regression, was selected using the highest area under the receiver operating characteristic curve (AUC) criterion. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. The model was then validated externally in an independent cohort of similar patients from the University of British Columbia.
The development cohort included 531 patients, in whom the incidence of POI was 16·8 per cent. The final model included five variables: age, ASA fitness grade, underlying pathology/treatment, interval between ileostomy creation and closure, and duration of surgery for ileostomy closure (AUC 0·68, 95 per cent c.i. 0·61 to 0·74). The model demonstrated good calibration (P = 0·142). The validation cohort consisted of 216 patients, and the incidence of POI was 15·7 per cent. On external validation, the model maintained good discrimination (AUC 0·72, 0·63 to 0·81) and calibration (P = 0·538).
A prediction model was developed for POI after loop ileostomy closure and included five variables. The model maintained good performance on external validation.
术后肠麻痹（POI）是回肠袢式造口关闭术后的一种严重并发症，其发生频率和对患者的影响都很大。本研究旨在开发和外部验证一种用于预测回肠袢式造口关闭后 POI 的预测模型。
根据预测模型开发和验证的 TRIPOD 清单，对模型进行了开发和验证。该研究的开发队列包括在加拿大蒙特利尔的两家教学医院接受回肠袢式造口关闭的连续患者。选择纳入模型的候选变量是基于主题知识预先确定的。使用最高的接受者操作特征曲线（AUC）标准，使用逻辑回归对 30 天 POI 的累积发生率进行建模，选择最终预测模型。通过 Hosmer-Lemeshow 拟合优度检验评估模型校准。然后，在不列颠哥伦比亚大学具有相似患者的独立队列中对模型进行外部验证。
该研究的开发队列包括 531 例患者，其中 POI 的发生率为 16.8%。最终模型包括 5 个变量：年龄、ASA 体能状况、基础病理/治疗、造口与关闭之间的间隔时间和回肠造口关闭的手术持续时间（AUC 为 0.68，95%置信区间为 0.61 至 0.74）。该模型显示出良好的校准（P=0.142）。验证队列包括 216 例患者，POI 的发生率为 15.7%。在外部验证中，该模型保持了良好的区分度（AUC 为 0.72，0.63 至 0.81）和校准（P=0.538）。
开发了一种用于预测回肠袢式造口关闭后 POI 的预测模型，包括 5 个变量。该模型在外部验证中保持了良好的性能。
