| Objective:To analyze the causes and risk factors of unplanned reoperation(URO)after laparoscopic radical gastrectomy through clinical data,and establish a nomogram risk prediction model,and to screen out high-risk patients,so as to guide clinical decision-making and reduce the occurrence of URO events.Methods:The clinical date of 2252 patients with gastric cancer who underwent laparoscopic radical gastrectomy from January 2016 to December 2018 in the gastrointestinal surgery of the First Affiliated Hospital of Nanchang University were retrospectively amalyzed.According to whether to perform unplanned reoperation,the patients were divided into URO group(38 cases)and control group(2214cases).The causes of URO events were analyzed,and 25 potential risk factors were analyzed by univariate analysis,and statistically significant indexes were selected(P< 0.05);Then the independent risk factors of URO were selected by multivariate Logistic regression analysis;The URO risk prediction model was constructed and evaluated according to the independent risk factors;The nomogram of URO was drawn by R software and internally validated.Results:The incidence of unplanned reoperation after laparoscopic radical gastrectomy was 1.7%.The main causes of URO were intraperitoneal hemorrhage(47.3%),duodenal stump fistula(15.8%),anastomotic fistula(13.2%),intestinal obstruction(10.5%).Independent risk factors for URO were identified by univariate analysis and multivariate Logistic regression analysis,including gender,comorbidity,age,preoperative albumin,and resection range.According to the independent risk factors,the risk prediction model of URO was constructed.The Hosmer-Lemehow method was used to detect the fitting degree(P=0.797)and the area under the ROC curve(AUC=0.792),indicating that the model had good calibration and discrimination.A nomogram was drawn based on the model.The C-Statistics was 0.792 and the average absolute error of calibration curve was 0.003 by Bootstrap self-sampling method,which also shows that the model had goodpredictive value.Conclusion:The most common cause of URO is intraperitoneal hemorrhage.Gen der,age,comorbidity,preoperative albumin,and resection range were independent risk factors.The nomogram of risk prediction model based on independent risk factors can be used to predict the occurrence of URO in high-risk patients. |
