Construction Of Risk Prediction Model Of Discharge With Double J Tube After Upper Urinary Calculi Operation

BackgroundAll patients with upper urinary calculi operation need indwelling double J tube,but most patients suffer varying degrees of symptoms related to ureteral stents,which can seriously affect the quality of life for patients and even induce serious complications.Therefore,it is extremely important to predict the risk for discharged patients with double J tube according to relevant risk factors.At present,there is still lack of clinical risk prediction model for discharged patients with double J tube after upper urinary calculi operation.In this study,the risk prediction model of discharged patients with double J-tube after upper urinary calculi operation was constructed,and we attempt to explore whether this model could identify the risk for such patients.We hope to provide a theoretical basis for the formulation of preventive measures.ObjectiveWe attempt to explore the risk factors for discharged patients with double J tube after upper urinary calculi operation and establish a prediction model.Methods1.Investigating on discharged status of patients with double J tube after upper urinary calculi operationThe questionnaires were self-designed and the items include patients’ age,gender,retention time,number,type,material,frequency of double J tubes,caregivers,medical conditions of the area where patients live,education level,basic diseases,nutrition status and self-care ability.The discharged status of patients with double J tube after upper urinary calculi operation were investigated according to the questionnaires above.2.Construction of risk items for discharged patients with double J tube after upper urinary calculi operationThe risk items were initially constructed and scores were assigned to form the risk assessment table for discharged patients with double J tube after upper urinary calculi operation by literature review and brainstorming.Delphi method was used to conduct the expert consultation.Experts who meeting the inclusion criteria were selected for two rounds of consultation.Finally,the risk items for discharged patients with double J tube after upper urinary calculi operation was determined.3.Construction of risk prediction model of discharged patients with double J tube after upper urinary calculi operationAccording to the risk items determined by expert consultation,435 patients with double J tube after upper urinary calculi operation in Zhujiang Hospital from January to December 2020 were included.Patients were divided into positive group(n=207)and negative group(n=228)based on the symptoms related to ureteral stent.The various indexes of the two groups were compared,and Logistic regression analysis was used to establish the risk prediction model of discharged patients with double J tube after upper urinary calculi operation,and the prediction effect of this model was verified by ROC curve.Results1.Investigating on discharged status of patients with double J tube after upper urinary calculi operation.Through the return visit,we found that the complication rate of discharged patients with double J tube after upper urinary calculi operation was 52.6%,and the main complications were gross hematuria and bladder irritation.Among the patients surveyed,only 86(37.7%)considered that the current health education approach met their needs and 144(63.2%)considered that they needed a more detailed intervention measurement.2.The risk items for discharged patients with double J tube after upper urinary calculi operation.12 experts were participated in the consultation totally.The expert authority coefficients of the two rounds of expert letter consultation were 0.883,0.883 0.883 and 0.883,0.759,0.821,respectively.In the two rounds of letter consultation,the harmony coefficient of all indicators scored by experts was 0.281 and 0.589 respectively,and the harmony coefficient was statistically significant in Kendall W significance test(p<0.05).After two rounds of expert consultation,the risk items for discharged patients with double J tube after surgery were summarized and compiled,including 5 first-level indicators and 26 second-level indicators..3.Risk prediction model of discharged patients with double J tube after upper urinary calculi operation.Stepped-regression analysis showed that daily water intake,hypertension,diabetes,postoperative stone residue and preoperative urine leucocyte quantification were independent risk factors,and the risk prediction model was established based on these risk items.The AUC value of this model was 0.906,and the sensitivity and specificity were 0.848 and 0.832 when the critical value was-0.17.ConclusionThis risk prediction model is effective and is valuable for clinical application.This model can provide objective reference for clinical medical staff to predict the risk for discharged patients with double J tube after upper urinary calculi operation.