老年患者腹壁切口疝修补术后复发的危险因素探讨及风险列线图模型的建立

Investigation on risk factors of recurrence after incisional hernia repair in elderly patients and establishment of risk nomogram model

目的探讨老年患者腹壁切口疝修补术后复发的危险因素,并建立预测老年患者腹壁切口疝修补术后复发的风险列线图模型。方法选取2014年1月至2019年12月于南京大学附属鼓楼医院进行诊治的260例行腹壁切口疝修补术老年患者作为研究对象,分析所选患者的临床资料,根据是否复发将所选患者分为复发组和正常组,采用Logistic回归分析筛选老年患者腹壁切口疝修补术后复发的危险因素,并建立老年患者腹壁切口疝修补术后复发的风险列线图模型。结果260例腹壁切口疝修补术老年患者中术后复发患者36例(13.85%)单因素分析结果显示,复发组和正常组患者性别、年龄、疝类型、疝部位、补片型号、固定补片、手术类型及饮酒史等资料差异均无统计学意义(P〉0.05),而手术时间、医师水平、术后血肿、吸烟史及肥胖等资料差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,手术时间≥120 min、医师水平、术后血肿、有吸烟史及肥胖等为老年患者腹壁切口疝修补术后复发的独立危险因素(P<0.05),均和老年患者腹壁切口疝修补术后复发高度相关。基于手术时间、医师水平、术后血肿、吸烟史及肥胖等老年患者腹壁切口疝修补术后复发的独立危险因素,建立预测老年患者腹壁切口疝修补术后复发的风险列线图模型,C-index指数为0.775(95%CI:0.728〜0.823),预测值与实测值基本一致,说明本列线图的辨别力较好,列线图模型预测老年患者腹壁切口疝修补术后复发的受试者工作特征曲线显示,曲线下面积为0.807,表明本研究列线图的预测价值较高。结论手术时间2120 mm、医师水平、术后血肿、有吸烟史及肥胖等为老年患者腹壁切口疝修补术后复发的独立危险因素,本研究所建立的列线图有助于预测老年患者腹壁切口疝修补术后复发的发生风险。

Objective To investigate the risk factors of recurrence after abdominal wall incisional hernia repair in elderly patients,and to establish a risk nomogram model for predicting recurrence after abdominal wall incisional hernia repair in elderly patients.Methods A total of 260 elderly patients with abdominal wall incisional hernia repair who were diagnosed and treated in the Drum Tower Hospital Affiliated with Nanjing University from January 2014 to December 2019 were selected as the research subjects.For the recurrence group and the normal group,logistic regression analysis was used to screen the risk factors of recurrence after abdominal wall incisional hernia repair in elderly patients,and a nomogram model for the risk of recurrence after abdominal wall incisional hernia repair in elderly patients was established.Results Among the 260 elderly patients with abdominal wall incisional hernia repair,36 patients(13.85%)had postoperative recurrence.Univariate analysis showed that there was no significant difference in gender,age,hernia type,hernia location,patch type,fixed patch,operation type,and drinking history between the recurrence group and the normal group(P>0.05),while there were significant differences in operation time,physician level,postoperative hematoma,smoking history and obesity(P<0.05).Logistic regression analysis showed that operation time 2120 minutes,physician level,postoperative hematoma,smoking history and obesity were independent risk factors for recurrence after abdominal wall incisional hernia repair in elderly patients(P<0.05),and both were highly correlated with the recurrence after incisional abdominal wall hernia repair in elderly patients.Based on the independent risk factors for recurrence after abdominal wall incisional hernia repair in elderly patients,such as operation time,physician level,postoperative hematoma,smoking history,and obesity,a nomogram model was established to predict the risk of recurrence after abdominal wall incisional hernia repair in elderly patients.The C-index was 0.775(95%CI:0.728-0.823),and the predicted value was basically the same as the measured value,indicating that the nomogram had better discrimination ability,and the nomogram model predicted the recurrence of elderly patients with abdominal wall incisional hernia repair.The operator operating characteristic curve shows that the area under the curve is 0.807,indicating that the nomogram in this study has a high predictive value.Conclusion Operation time≥120 minutes,physician level,postoperative hematoma,smoking history and obesity are independent risk factors for recurrence after abdominal wall incisional hernia repair in elderly patients.The nomogram established in this study can help predict the abdominal wall of elderly patients.The risk of recurrence after incisional hernia repair.