Nomogram for predicting severe abdominal adhesions prior to definitive surgery in patients with anastomotic fistula post-small intestine resection: a cohort study

作者：Zheng Yao, Weiwei Shang, Fan Yang, Weiliang Tian, Guoping Zhao, Xin Xu, Risheng Zhao, Tian Tao, Wuhan Li, Ming Huang, Yunzhao Zhao, Qian Huang · 发表于：International Journal of Surgery · 年份：2024 · DOI：10.1097/js9.0000000000002191 · 被引用次数：6 · 研究领域：Intestinal and Peritoneal Adhesions、Colorectal Cancer Surgical Treatments、Intraperitoneal and Appendiceal Malignancies

BACKGROUND: This study aimed to develop and validate a nomogram for predicting the presence of severe intra-abdominal adhesions before definitive surgery (DS) for anastomotic fistula following small intestine resection (SIR). METHODS: Patients were enrolled from January 2009 to October 2023 and were randomly divided (2:1) into development and validation cohorts. Predictors of severe adhesion were identified and integrated into a nomogram. The nomogram's performance was evaluated through calibration, discrimination, and clinical utility. Results : A total of 414 patients were included, with 276 in the development cohort and 138 in the validation cohort. Severe adhesion was diagnosed in 54 (13%) patients, including 37 (13.4%) in the development cohort and 17 (12.3%) in the validation cohort ( P = 0.76). Five predictors were identified: Sequential Organ Failure Assessment score, duration of early-stage abdominal infection, preoperative albumin (Alb) <35 g/L, visceral to subcutaneous fat area ratio, and preoperative C-reactive protein >10 mg/L. The nomogram demonstrated robust discrimination, with a concordance index (C-index) of 0.80 (95% CI, 0.76-0.90) in internal validation, and was well-calibrated. In the validation cohort, the model maintained good discrimination (C-index = 0.79; 95% CI, 0.67-0.94) and calibration. Decision curve analysis affirmed the nomogram's clinical utility. CONCLUSION: This study introduces a practical nomogram for assessing the risk of severe abdomina...