The Building And Validation Of Prediction Model For Risk Of Postoperative Fecal Soiling In Children With Hirschsprung’s Disease

Objective:(1)To develop the fecal soiling risk factor questionnaire for postoperative children with Hirschsprung’s disease(HSCR)(hereafter referred to as HSCR postoperative questionnaire of fecal soiling risk factor).(2)To build and validate a postoperative risk prediction model of fecal soiling for children with HSCR(hereafter referred to as HSCR postoperative model for fecal soiling risk prediction)so as to provide a screening tool for the early identification and intervention of at-risk individuals with HSCR postoperative fecal soiling.Methods:(1)The formulation of a HSCR postoperative questionnaire of fecal soiling risk factor:In this part,it includes the following methods used to formulate the questionnaire.First,Review literature and design a draft HSCR postoperative questionnaire of fecal soiling risk factor.Second,Organize an in-hospital expert panel discussion to form the first draft of the HSCR postoperative questionnaire of fecal soiling risk factor.Third,through expert consultation,establish a definitive HSCR postoperative questionnaire of fecal soiling risk factor.(2)The building and validation of the HSCR postoperative model for fecal soiling risk prediction.In this part,a total of 377 children who underwent surgery for HSCR from three Grade 3A hospitals in Guangxi,China,between January 2016 and June 2021,were retrospectively selected for the study,and randomly divided into the modeling group(n=264)and the testing model group(n=113)with the ratio of 7:3.The modeling group was divided into the group with fecal soiling(n=92)and without group(n=172)based on whether postoperative fecal soiling occurs or not.And risk prediction models were built by analyzing postoperative risk factors of fecal soiling using univariate and multivariate logistic regression.The area under the Receiver Operator Characteristic Curve was used to test the identification ability of the model,that is,discrimination.And the Hosmer lemeshow chi square was used to test the goodness of fit of the model.21 children with the disease from August to December2021 were selected for prospective validation of the model.Results:(1)HSCR postoperative questionnaire of fecal soiling risk factor:Through expert consultation,a questionnaire with 15 item risk factors was developed from 4 perspectives including preoperative,intraoperative,postoperative,and family situations.(2)Building of HSCR postoperative model for fecal soiling risk prediction:435 cases of children with disease were collected according to the inclusion and exclusion criteria.58 cases were excluded for reasons such as incomplete information,and 377 cases were finally included.Among them,131 cases of postoperative fecal soiling occurred with an incidence of34.75%.After univariate analysis,Multivariate analysis of variables with P<0.1 in the modelling group showed six factors(P<0.05)including the length of bowel resection,implementation of postoperative diet by caregivers in children,postoperative defecation training by caregivers in children,presence of the Soave procedure(including transanal, laparoscopic and open Soave procedure),special type of megacolon(including long segment type,whole colon and whole bowel type),and presence of Caregivers being illiterate were predictors of the development of postoperative fecal soiling of HSCR.(3)The building of HSCR postoperative model for fecal soiling risk prediction:logitp=-2.385+0.105×Length of bowel resection+0.808×Caregivers’implementation of postoperative diet in children+0.867×Caregiver training on postoperative bowel movements in children+0.929×presence of Soave procedure+1.697×Special type megacolon+2.065×Caregivers were illiterate.(4)Validation of the HSCR postoperative model for fecal soiling risk prediction:(1)Hosmer lemeshow chi square test((?)~2=6.649,(P=0.575>0.05).(2)The AUC of the ROC curve of the model group was 0.849(95%CI:0.801-0.898),and when the Youden index value was maximum=0.53,the optimal model cut-off value(logitp)=0.32,sensitivity 76.00%,and specificity 77.00%.(3)The AUC of ROC curve of the testing model group was 0.736,(95%CI:0.684-0.871),with a sensitivity of 81.25%and a specificity of 78.46%.(4)Prospective validation of the HSCR postoperative model for fecal soiling risk prediction showed:the present prediction model was 66.67%sensitive and 100%specific after comparing the predicted result with the actual result.Conclusions:This study was conducted to preliminarily establish a HSCR postoperative questionnaire of fecal soiling risk factor through methods such as expert consultation;After multivariate analysis,we found that the length of bowel resection,the implementation of postoperative diet by caregivers,the training of caregivers on postoperative defecation in children,the Soave procedure,the special type of megacolon,and illiteracy of caregivers were the risk factors for the occurrence of postoperative fecal soiling of HSCR;To construct and verify the risk prediction model of fecal contamination after HSCR operation.The model has good applicable value and can predict the occurrence of fecal contamination after operation to a certain extent,providing reference for medical staff to identify and manage high-risk groups of fecal contamination after operation in the early stage.