The Establishment Of Risk Screening Score Scale Based On Prediction Models And Intervention Process For Postoperative Fatigue After Gastrointestinal Tumor Surgery

Background Gastrointestinal tumors have high morbidity and mortality in the world and continue to increase.Surgery is the major treatment of these diseases.Postoperative fatigue(POF)is a common symptom of postoperative fatigue,such as fatigue,insomnia,inattention,depression,tension,anxiety,etc.,which seriously affects patients prognosis and life quality and increases the burden on caregivers.In recent years,more and more researchers begin to pay attention on the assessment,prevention and intervention of POF to improve the clinical outcomes of patients.However,there is no specific POF assessment tool in China at present.In 2016,foreign scholars deleted 31 items of the perioperative fatigue assessment scale to form a concise version of 10 items,but there is no Chinese version at present.In addition,the researches on risk factors of POF are limited and there is no risk screening score scale.Although many interventions focus on POF,there is still a huge gap between China and the West.No effective and targeted intervention process for patients after gastrointestinal tumor surgery.Therefore,in order to fulfill accurate clinical assessment,risk identification and effective intervention,it is necessary to develop a suitable assessment tool for Chinese patients,to construct prediction models through prospective study and the risk screening score scale,to determine the intervention and prevention through systematic review.Objective1.To translate the 10-item Identity-Consequence Fatigue Scale and to carry out the reliability and validity test and determine the cut-off point.2.To develop and pick out the best prediction model for POF and to establish a risk screening scale based on the model and validate it.3.To evaluate current interventions for fatigue after gastrointestinal tumor surgery by meta analysis and systematic review and to construct intervention process.Methods1.The 10-item ICFS was translated into Chinese and adapted to Chinese culture followed the guideline recommended by American Academy of Orthopaedic Surgeons Evidence Based Medicine Committee.A total of 74 patients in the First Affiliated Hospital of Nanjing Medical University with gastrointestinal tumor were recruited and were investigated by the Chinese version of 10-item ICFS.The reliability and validity were tested.The cut-off point is defined by receiver operating characteristic curve and threshold effect analysis.2.60 patients who underwent gastrointestinal tumor surgery in the First Affiliated Hospital of Nanjing Medical University from January to June 2018 were included for statistical analysis.Relevant physiological,psychological,and social data were collected before surgery.The independent risk factors of postoperative fatigue were screened by univariate analysis and multivariate analysis,and substituted into the binary logistic regression model,BP neural network model and decision tree.The AUC and generalization ability of the model tester were compared to select the optimal model.On this basis,the postoperative fatigue risk screening score scale was formed,and the reliability and validity analysis and cut-off value were determined.Finally,105 patients were included to test the scale.3.Literature searches were conducted in databases including PubMed,EMbase,Web of Science,SCIENCE DIRECT,Cochrane Library,CINAHL,CNKI,VIP,WANFANG,up to September 2018.RCTs were assessed with with the Cochrane risk-of-bias assessment tool and data synthesis by meta-analysis was performed.Finally,evidence was extracted to construct the POF intervention process.Results1.The Chinese version of ICFS retained 10 entries and the content validity index was 0.96.Item analysis indicated each item in the critical ratio was significant,and the correlation coefficients to the total scores reached above 0.5.Exploratory factor analysis indicated that the scale consisted of 2 factors which explained of 77.337% of total variance,and factor loading of all 10 items was higher than 0.4.Strong correlations were found with cancer-related fatigue.The internal consistency reliability coefficients were 0.928 for total scale,0.907 and 0.877 for the 2 factors respectively.The criterion validity with cancer-related fatigue is 0.874.The ROC curve showed when the score of ICFS-10 was 22,the Youden index was the largest,and the threshold effect analysis showed that the value was 24 according to hand grip.Therefore,the cut-off point of patients after gastrointestinal tumor surgery is 24.2.The AUC for binary logistic regression model,BP neural network model and decision tree model was 0.857,0.894,0.774 respectively and all models had a good generalization ability;BP neural network model was the optimal model and it included tumor stage,education level,personal monthly income,subjective support,age,preoperative anxiety and depression,preoperative albumin;the risk screening scale scored 0 to 15 points.The CVI was 0.90 and from 0.80 to 1.00 respectively.Exploratory factor analysis indicated that scale consisted of 3 factors which explained of 66.042% of total variance,and factor loading of all 10 items was higher than 0.4.The internal consistency reliability coefficients were 0.730 for total scale,0.839,0.763 and 0.637 for the 3 factors respectively.The ROC showed AUC was 0.839 andthe cut-off value was 8;in the stage of scale verification,the total postoperative fatigue prediction accuracy was 90.5%.3.Seventy studies with a total of 6171 participants were included,systematic review and intervention process was conducted.The evidence from included studies proved the efficiency of early nutrition support,high chain amino acid formula,psychological intervention and Traditional Chinese Medicine.Sodium creatine phosphate,exercise,glucocorticoid or small doses human growth hormone can reduce short-term fatigue after specific gastrointestinal tumor surgery.Conclusion1.The Chinese version of scale has good reliability and validity and can be used to access postoperative fatigue.The cut-off point is 24 and can be used as a warning for the adverse effects on both physiological and psychological health.2.The postoperative fatigue risk screening score scale for gastrointestinal tumors based on BP neural network model has good reliability and validity and can be used to predict postoperative fatigue and provide guide for risk screening and targeted prevention.3.Effective short-term fatigue intervention measures for postoperative gastrointestinal tumors have been clearly defined,but the long-term effects of exercise,glucocorticoid,psychological intervention and other interventions are still controversial,which still need to be verified in clinical practice.The constructed intervention process still needs further clinical verification and improvement.