Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd. West, Shanghai, China.
Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Updates Surg. 2022 Aug;74(4):1375-1382. doi: 10.1007/s13304-021-01196-z. Epub 2021 Oct 24.
Postoperative pulmonary complications (PPCs) are the most common complications following minimally invasive esophagectomy (MIE) and can be associated with adverse outcomes. This study aims to construct a nomogram based on clinical factors to predict PPCs and investigate related early outcomes. Clinical data of 969 consecutive patients receiving MIE were retrospectively collected. Univariate and multivariate analysis were performed to select independent predictors. Using independent predictors to develop a nomogram and using a bootstrap-resampling approach to conduct internal verification. Early outcomes of PPCs were analyzed. The incidence of PPCs following MIE was 39.6% (384 out of 969). In multivariate analysis, older age (Odds ratio (OR) 1.034, P < 0.001), higher body mass index (OR 0.993, P = 0.003), heavy smoking (OR 1.396, P = 0.027), FEV/FVC < 105% (OR 1.958, P < 0.001), chemoradiotherapy (OR 0.653, P = 0.039), estimated blood loss ≥ 400 mL (OR 2.582, P = 0.018), general anesthesia (vs Combined thoracic paravertebral blockade, OR 1.578, P = 0.014), operative time ≥ 240 min (OR 1.388, P = 0.027), squamous cell carcinoma (OR 2.099, P = 0.036) and conversion to thoracotomy (OR 2.820, P = 0.026) were independent predictors for PPCs. These ten independent predictors were used to develop a nomogram, with concordance index (C index) value of 0.662 and good calibration. After internal validation, similarly good calibration and discrimination (C index, 0.654; 95% CI 0.614-0.690) were observed. Patients developing PPCs had higher rates of anastomotic leakage, reoperation, ICU and 30-day readmissions, and prolonged ICU and hospital stays (P < 0.05). Our study identified ten predictors for PPCs, which were associated with poor early outcomes. The proposed nomogram can be a useful tool to identify patients at high risk of PPCs after MIE.
术后肺部并发症(PPCs)是微创食管切除术(MIE)后最常见的并发症,并可能导致不良后果。本研究旨在构建一个基于临床因素的列线图,以预测 PPCs 并探讨相关的早期结局。回顾性收集了 969 例接受 MIE 的连续患者的临床数据。进行单因素和多因素分析以选择独立预测因子。使用独立预测因子构建列线图,并使用自举重采样方法进行内部验证。分析 PPCs 的早期结局。MIE 后 PPCs 的发生率为 39.6%(969 例中有 384 例)。多因素分析显示,年龄较大(优势比(OR)1.034,P<0.001)、体重指数较高(OR 0.993,P=0.003)、重度吸烟(OR 1.396,P=0.027)、FEV/FVC<105%(OR 1.958,P<0.001)、放化疗(OR 0.653,P=0.039)、估计出血量≥400 mL(OR 2.582,P=0.018)、全身麻醉(与联合胸段椎旁阻滞相比,OR 1.578,P=0.014)、手术时间≥240 min(OR 1.388,P=0.027)、鳞状细胞癌(OR 2.099,P=0.036)和中转开胸(OR 2.820,P=0.026)是 PPCs 的独立预测因子。这十个独立预测因子用于开发列线图,一致性指数(C 指数)值为 0.662,校准良好。内部验证后,同样观察到良好的校准和区分度(C 指数,0.654;95%CI 0.614-0.690)。发生 PPCs 的患者吻合口漏、再次手术、ICU 和 30 天再入院以及 ICU 和住院时间延长的发生率更高(P<0.05)。我们的研究确定了 PPCs 的十个预测因子,这些预测因子与不良的早期结局相关。所提出的列线图可作为识别 MIE 后 PPCs 高危患者的有用工具。
Medicine (Baltimore). 2021-8-6
J Gastrointest Oncol. 2022-4