食管裂孔疝手术后24小时内出院影响因素分析及预测模型构建

Analysis of independent factors and construction of predictive model of discharge within 24 hours after operation of hiatal hernia

目的分析腹腔镜食管裂孔疝手术后24小时内出院的影响因素,并构建预测24小时内出院的评分模型。方法2017年10月~2019年10月我院收治的食管裂孔疝手术病人32例,根据是否24小时出院分为两组,单因素分析两组病人一般资料及手术相关指标,单因素分析有意义的指标再行Logistic回归分析,分析其独立危险因素,根据独立危险因素构建预测模型。结果32例食管裂孔疝病人中,13例(40.8%)术后24小时内出院。术者日间手术实施经历、手术时间是食管裂孔疝术后24小时内出院的独立危险因素。基于此两项因素构建的预测模型,当模型分值超过1.408时,该病例实现术后24小时内出院,即阳性预测率1.000(95%CI:0.735~1.000),反之阴性预测率0.950(95%CI:0.751~0.999)。预测模型AUC为0.992(95%CI:0.973~1.000),敏感度为0.923(95%CI:0.640~0.998),特异度为1.000(95%CI:0.823~1.000),准确度为0.969(95%CI:0.838~0.999)。临床决策曲线显示,采用该预测模型在任何风险概率下均有明显临床获益。结论基于术者日间手术实施经历与手术时间建立的评分模型可准确预测食管裂孔疝病人术后24小时内出院可能性。

Objective To analyze the independent factors of discharge within 24 hours after operation of hiatal hernia and to construct a scoring model to predict discharge within 24 hours.Methods The clinical data of 32 patients with hiatal hernia in Xijing Hospital from October 2017 to October 2019 were retrospectively analyzed,and the independent risk factors affecting discharge 24 hours after operation were analyzed.According to the weight of risk factors,a scoring model was constructed to predict discharge 24 hours after hiatal hernia operation.Results In all 32 patients with hiatal hernia,13(40.8%)were discharged within 24 hours after operation.The surgeon with experience on day surgery and the time of operation were independent risk factors of discharge within 24 hours after operation.The prediction model was constructed based on these two factors.When the model score exceeded 1.408,the case was discharged within 24 hours after operation.The positive prediction rate was 1.000(95%CI:0.735-1.000),whereas the negative prediction rate was 0.950(95%CI:0.751-0.999).Predicted model AUC 0.992(95%CI:0.973-1.000),sensitivity0.923(95%CI:0.640-0.998),specificity1.000(95%CI:0.823-1.000),accuracy0.969(95%CI:0.838-0.999).The clinical decision curve shows that the use of this prediction model has significant clinical benefits under any risk probability.Conclusion A scoring model based on surgeon with experience on day surgery and operation time can accurately predict the possibility of discharge within 24 hours after operation.