Establishment Of Logistic Model Of Postoperative Severe Complications And Multivariable Logistic Analysis Of Mortality Of Gastric Carcinoma

Objective: To investigate the main risk factors of postoperative severe complications and death in gastric carcinoma, to establish the Logistic regressive model and to evaluate the accuracy,sensitivity and specificity for predicting postoperative severe complications.Methods: Using case-control studies, univariate analysis and binary Logistic regressive analysis were used to retrospectively analyze the clinical data related to postoperative severe complications and death of 1728 gastric carcinoma patients following gestrectomy.Results:Binary Logistic analysis found that extent of nodal dissection(N₂⁺-N₃) (OR=12.468,95%CI:5.330-29.168),chronic obstructive pulmonary disease (COPD) (OR=5.999, 95%CI:2.411-14.744), invasion to the adjacent organ (OR=4.747, 95%CI:2.374-9.492),combined organ resection (OR=4.714,95%CI:2.370-9.378), extent of nodal dissection(N₂) (OR=3.560, 95%CI:1.597-7.937) , diabetes mellitus(DM) (OR=3.157,95%CI:1.517-6.568), neoplasm TNM stagingâ…£(UICC,1997) (OR=3.006, 95%CI:1.587-5.694),heart diseases(OR=2.668, 95%CI: 1.420-5.012),malnutrition (OR=2.264, 95%CI:1.302-3.936), surgeon's operative volume (OR=1.929, 95%CI:1.076-3.457),operative time (OR=1.783, 95%CI: 1.383-2.300),blood loss(OR=1.719,95%CI:1.530-1.931) and age (OR=1.363, 95%CI:1.176-1.579) were the independent risk factors associated with severe complications and the Logistic regression equation was P=l/(1+e^{14.806-2.523X1-1.792X2-1.558X3-1.551X4-1.270X5-1.150X6-1.101X7-0.981X8-0.817X9-0.657X10-0578X11-0.542X12-0.309X13}A test sample showed the accuracy, sensitivity and specificity of the Logistic model were 72.5%, 70%, 75%, respectively. Seven risk factors including heart diseases(OR-5.163, 95%C7: 1.633-16.322),invation to the adjacent organ (OR=5.024, 95%CI:1.713-14.736) , intro-abdominal infection (OR=4.570, 95%CI:1.532-13.632) , COPD (OR=3.828,95%CI:1.148-14.821),operative time (OR=1.675, 95%CI:1.062-2.643), age (OR=1.482,95%CI:1.063-2.067) and blood loss (OR=1.042, 95%CI: 1.004-1.082) were the independent risk factors correlated to mortality.Conclusion: Postoperative severe complications of gastric carcinoma is associated with 13 risk factors, including extent of nodal dissection(N2+-N3), COPD, invasion to the adjacent organ, combined organ resection, extent of nodal dissection(N2), DM, neoplasm TNM stagingâ…£(UICC,1997), heart diseases, malnutrition, surgeon's operative volume, operative time, blood loss and age and the Logistic regressive model based on these factors is reliable in predicting the postoperative severe complications. On the other hand, significant positive predictors of mortality include heart diseases, invation to the adjacent organ, intro-abdominal infection, COPD, operative time, age and blood loss.