Dataset Information

Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery.

ABSTRACT:

Objectives

This study aimed to develop a nomogram for predicting the risk of pressure injury (PI) in adult patients undergoing abdominal surgery and validate its effectiveness among these patients.

Methods

This study retrospectively included 11,247 adult patients, who underwent abdominal surgery and postoperative supervision in ICU, in a tertiary care hospital in western China between January 2017 and December 2020. All datasets were extracted from the patient's medical records and randomly divided into the training cohort (8,997) and the validation cohort (2,250) by 8:2. The univariable logistic regression was used to select potentially relevant features. Then, multivariable logistic regression was also conducted and utilized to establish the nomogram. The nomogram was compared with the Braden scale for predicting PI in the validation cohort through the area under the curve (AUC) of the receiver operator characteristic (ROC) curve, Hosmer-Lemeshow (H-L) test, and decision curve analysis (DCA).

Results

873 (7.8%) patients suffered PIs. Logistic regression analysis showed that time of operation, weight, type of operation, albumin, and Braden scale score were independent risk factors for PI. A nomogram integrating five selected characteristics was constructed. The AUC of the ROC curve for the nomogram was 0.831, with a specificity of 85.2% and sensitivity of 63.7%. The AUC of the ROC curve for the Braden scale was 0.567, with a specificity of only 33.0%. The P-values of the H-L test were 0.45 (nomogram) and 0.22 (Braden scale), both indicating good calibration. The DCA also displayed that the nomogram had better predictive validity.

Conclusion

Compared with the Braden scale, the nomogram showed a better predictive performance. This nomogram is informative and has the potential to better guide caregivers for risk stratification and prevention of PI, although it requires further validation.

SUBMITTER: Feng X

PROVIDER: S-EPMC9587389 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery.

Feng Xue X Wang Meng M Zhang Ya Y Liu Qian Q Guo Mingyang M Liang Hongyin H

International journal of nursing sciences 20220924 4

<h4>Objectives</h4>This study aimed to develop a nomogram for predicting the risk of pressure injury (PI) in adult patients undergoing abdominal surgery and validate its effectiveness among these patients.<h4>Methods</h4>This study retrospectively included 11,247 adult patients, who underwent abdominal surgery and postoperative supervision in ICU, in a tertiary care hospital in western China between January 2017 and December 2020. All datasets were extracted from the patient's medical records an ...[more]

PMID: 36285073

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Project description:BackgroundPostoperative pulmonary complications (PPCs) remain a prevalent concern among elderly patients undergoing surgery, with a notably higher incidence observed in elderly patients undergoing thoracic surgery. This study aimed to develop a nomogram to predict the risk of PPCs in this population.MethodsA total of 2963 elderly patients who underwent thoracic surgery were enrolled and randomly divided into a training cohort (80%, n = 2369) or a validation cohort (20%, n = 593). Univariate and multivariate logistic regression analyses were conducted to identify risk factors for PPCs, and a nomogram was developed based on the findings from the training cohort. The validation cohort was used to validate the model. The predictive accuracy of the model was evaluated by receiver operating characteristic (ROC) curve, area under ROC (AUC), calibration curve, and decision curve analysis (DCA).ResultsA total of 918 (31.0%) patients reported PPCs. Nine independent risk factors for PPCs were identified: preoperative presence of chronic obstructive pulmonary disease (COPD), elevated leukocyte count, higher partial pressure of arterial carbon dioxide (PaCO2) level, surgical site, thoracotomy, intraoperative hypotension, blood loss > 100 mL, surgery duration > 180 min, and malignant tumor. The AUC value for the training cohort was 0.739 (95% CI: 0.719-0.762), and it was 0.703 for the validation cohort (95% CI: 0.657-0.749). The P-values for the Hosmer-Lemeshow test were 0.633 and 0.144 for the training and validation cohorts, respectively, indicating a notable calibration curve fit. The DCA curve indicated that the nomogram could be applied clinically if the risk threshold was between 12% and 84%, which was found to be between 8% and 82% in the validation cohort.ConclusionThis study highlighted the pressing need for early detection of PPCs in elderly patients undergoing thoracic surgery. The nomogram exhibited promising predictive efficacy for PPCs in elderly patients undergoing thoracic surgery, enabling the identification of high-risk patients and consequently aiding in the implementation of preventive interventions.

Project description:BackgroundThe ARISCAT score, a prospectively developed generic classification for postoperative pulmonary complications (PPCs), has shown excellent predictive performance in general surgery. However, there is no reliable classification instrument for PPCs prediciton in thoracic surgery.ObjectiveThis study aimed to develop and validate a novel nomogram for estimating the risk of pulmonary complications in older patients (≥ 65 years) within 30 days after NCTS.MethodsA nomogram was developed using predefined candidate predictors of 30-day PPCs. It was fitted with least absolute shrinkage and selection operator and logistic regression methods. Internal validation was performed using a bootstrap-resampling approach, while external validation used an independent, temporally separated cohort. The model's performance was assessed based on its discriminative potential (area under the receiver operating characteristic curve [AUC]), predictive ability (calibration plots), and clinical utility (net benefit).ResultsIn the development (n = 1449) and validation (n = 449) cohorts, 34.9% and 31.4% of patients, respectively, developed pulmonary complications 30 days post-surgery. The final nomogram incorporated eight predictors (age, surgical approach, desaturation of < 92% for more than 2 min, duration of surgery, smoking status, FEV1/FVC%, respiratory infection in the last 30 days, and neoadjuvant chemotherapy). The nomogram showed excellent discrimination (AUC = 0.866, 95% confidence interval [CI], 0.846-0.885), calibration (Hosmer- Lemeshow test, P = 0.97) and overall performance (Brier score = 0.014) in the development cohort. Similar results were observed in the external validation cohort (AUC = 0.825, 95% CI, 0.786-0.864). A decision curve analysis indicated that the nomogram offers a positive net benefit compared with the ARISCAT and LAS VEGAS scores.ConclusionsThis novel nomogram can reliably identify older patients with a high risk for pulmonary complications within 30 days after NCTS.Trial registrationChiCTR2100051170.

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Project description:BackgroundThoracic epidural anesthesia (TEA) is associated with a knowledge gap regarding its mechanisms in lung protection and reduction of postoperative pulmonary complications (PPCs). Driving pressure (ΔP), an alternative indicator of alveolar strain, is closely linked to reduced PPCs with lower ΔP values. We aim to investigate whether TEA contributes to lung protection by lowering ΔP during mechanical ventilation.MethodsIn this prospective, randomized, patient and evaluator-blinded parallel study, adult patients scheduled for elective major upper abdominal surgery were assigned to either the TEA group with combined thoracic epidural anesthesia and general anesthesia (TEA-GA) (n = 30) or the control group with only general anesthesia (GA) (n = 30).MeasurementsThe primary outcome was the minimum ΔP determined based on positive end-expiratory pressure (PEEP) after intubation. Secondary outcomes included the incidence of PPCs within seven days, the minimum ΔP at various time points, blood gas analysis, intensive care unit (ICU) admission rates, length of hospital stay, and 30-day mortality rate.ResultsThe TEA group had a significantly lower minimum ΔP titrated based on PEEP compared to the control group (11.23 ± 2.19 cmH2O vs. 12.67 ± 2.70 cmH2O; P = 0.028). Multivariate linear regression analysis showed that intraoperative TEA application (compared with its absence; unstandardized beta coefficient (B) = -1.289; P = 0.008) significantly correlated with ΔP. The incidence of PPCs did not differ significantly between the two groups (8 of 30 [26.7%] vs. 12 of 30 [40%]; P = 0.273), but the incidence of atelectasis in the TEA group was significantly lower than in the control group (5 of 30 [16.7%] vs. 12 of 30 [40.7%]; P = 0.012). Multivariate logistic regression analysis indicated that ΔP was the only variable significantly associated with PPCs (Adjusted Odds Ratio [OR] = 2.190; 95% Confidence Interval [CI]: 1.300 to 3.689; P = 0.003).ConclusionCompared to GA, TEA-GA can reduce intraoperative ΔP in patients undergoing major upper abdominal surgery, especially those undergoing laparoscopic surgery. However, compared to GA combined with ΔP-guided ventilation, TEA-GA combined with ΔP-guided ventilation does not reduce the risk of PPCs. There was no significant difference in the total use of various vasoactive drugs between the two groups.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (registration number ChiCTR2300068778 date of registration February 28, 2023).

Dataset Information

Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery.

Objectives

Methods

Results

Conclusion

Publications

Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery.

Similar Datasets

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