Department of Anorectal Center, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, Shandong, China.
Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
J Gastrointest Surg. 2023 Jun;27(6):1216-1227. doi: 10.1007/s11605-023-05659-z. Epub 2023 Mar 29.
Recurrence after operated adhesive small bowel obstruction (ASBO) is a threatening potentiality for patients and a therapeutic dilemma facing any surgeon. Yet, little is known about screening tools to identify patients at higher risk of recurrence. The present study aimed to determine the risk factors of recurrence in patients operated on for ASBO and to construct a reliable predictive model capable of quantifying the risk of recurrence, which will be a practical tool to guide individualized patient management.
We developed a best-fit nomogram using data from a training cohort of 454 patients with ASBO treated surgically at the Affiliated Hospital of Qingdao University from 2012 through 2021. The nomogram was developed based on variables independently associated with recurrent ASBO screened via multivariate logistic regression. This model was validated using data from an independent internal cohort of 194 patients at the same institution and an external cohort of 196 patients at Qilu Hospital of Shandong University. Both internal and external validation was performed with a bootstrap resampling method (1000 iterations). The predictive accuracy of the nomogram was evaluated using Harrell's concordance index (C index) and calibration curve.
Eight-one out of 648 (12.5%) patients experienced at least one ASBO relapse with a median follow-up of 37 (interquartile range, 18-70) months. Univariate and multivariate analyses identified the following independent predictive factors associated with recurrence: diabetes mellitus (P = 0.004), preoperative albumin levels (P = 0.002), omentectomy (P = 0.002), matted adhesions (P = 0.036), and the approach of surgery (P = 0.008). Incorporating these five predictors, our nomogram predicted recurrent ASBO with C-index scores of 0.932 (95% CI 0.867-0.996) in the training cohort, 0.874 (95% CI 0.706-1) in the internal validation cohort, and 0.852 (95% CI 0.667-0.920) in the external validation cohort. The predictive model showed a very good fitting degree.
The development of a practical, easy-to-use nomogram for calculating the risk of recurrence in patients with ASBO treated surgically will enable physicians to tailor therapeutic strategies and monitor disease in advance.
术后粘连性小肠梗阻（ASBO）复发对患者构成严重威胁，也是所有外科医生面临的治疗难题。然而，目前尚缺乏用于识别高复发风险患者的筛查工具。本研究旨在确定接受手术治疗的 ASBO 患者复发的相关风险因素，并构建一种能够量化复发风险的可靠预测模型，为指导个体化患者管理提供实用工具。
我们使用 2012 年至 2021 年期间在青岛大学附属医院接受手术治疗的 454 例 ASBO 患者的训练队列数据，开发了一个最佳拟合诺莫图。该诺莫图基于多变量逻辑回归筛选出的与复发性 ASBO 独立相关的变量。通过对同一机构的 194 例内部验证队列和山东大学齐鲁医院的 196 例外部验证队列数据进行验证。内部和外部验证均采用自举重采样方法（1000 次迭代）。通过 Harrell 一致性指数（C 指数）和校准曲线评估诺莫图的预测准确性。
648 例患者中，81 例（12.5%）至少发生一次 ASBO 复发，中位随访时间为 37（四分位距 18-70）个月。单因素和多因素分析确定了与复发相关的独立预测因素：糖尿病（P=0.004）、术前白蛋白水平（P=0.002）、大网膜切除术（P=0.002）、粘连呈糊状（P=0.036）和手术入路（P=0.008）。纳入这五个预测因子后，我们的诺莫图在训练队列中的预测复发性 ASBO 的 C 指数评分为 0.932（95%CI 0.867-0.996），内部验证队列为 0.874（95%CI 0.706-1），外部验证队列为 0.852（95%CI 0.667-0.920）。预测模型具有很好的拟合度。
开发一种用于计算接受手术治疗的 ASBO 患者复发风险的实用、易于使用的诺莫图，将使医生能够制定个体化的治疗策略并提前监测疾病。
