Analysis Of Risk Factors For Postoperative Incision Infection Of Colorectal Cancer And Construction Of Risk Prediction Model

Objective1.Through literature review and expert meeting methods,identify the risk factors for postoperative incision infection in colorectal cancer surgery patients,and form a related risk factor questionnaire.2.Apply this table to collect relevant clinical data of colorectal cancer surgery patients,organize and conduct univariate analysis,and establish a predictive model for postoperative wound infection risk of colorectal cancer surgery patients based on logistic regression.This provides a data model for the development of a specific screening tool for evaluating wound infection risk in colorectal cancer surgery patients.3.Conduct external validation of the established model to enable medical staff to timely,accurately,and comprehensively grasp the risk changes of patient incision infection,conduct prospective prevention and evaluation,and further choose personalized treatment and nursing plans.Methods1.Establish the risk factors for postoperative I-SSI in colorectal cancer patients,search the Chinese and English databases through literature review,screen and extract relevant literature based on inclusion and exclusion criteria,and select potential risk factors related to postoperative I-SSI in colorectal cancer patients.Through expert meetings,expert consultation is conducted from different perspectives and expert advice is provided to determine the relevant risk factors for postoperative I-SSI in colorectal cancer and develop a risk factor questionnaire.2.Using the convenient sampling method,according to the electronic medical record information system of a top three hospital in Inner Mongolia,we retrospectively collected the information data of patients who received colorectal cancer surgery in a top three hospital in Inner Mongolia from January 2020 to December 2021.The patients who met the inclusion and exclusion criteria(70% of the total sample size)were the modeling group,and analyzed the general demography data,past history,surgical conditions,perioperative conditions and other data of patients,Use univariate analysis to screen out risk factors related to postoperative I-SSI in colorectal cancer patients,and use them as independent variables to enter logistic regression analysis.After obtaining the results,determine the partial regression coefficients of each risk factor β Value and obtain the equation,and finally complete the construction of the risk prediction model.3.Prospectively collect colorectal cancer patients who met the inclusion and exclusion criteria(30% of the total sample size)from January 2022 to December 2022 as the validation group for validation analysis,use H-L(Hosmer Leishow)test to test the Goodness of fit of the established prediction model for I-SSI after colorectal cancer surgery,and use the data of patients in the validation group to draw the ROC curve,To evaluate the ability of the predictive model constructed in this study to distinguish between I-SSI and non I-SSI patients.Results1.Literature review and final inclusion: 3 clinical practice guidelines and 7 systematic evaluations,totaling 10 articles.Conduct an expert meeting on the risk factors for postoperative I-SSI in colorectal cancer based on the collected literature,identify a total of 24 related risk factors in 4 aspects of postoperative I-SSI in colorectal cancer,and develop a risk factor questionnaire.2.This study collected a total of 715 colorectal cancer surgical patients who met the inclusion and exclusion criteria,including 67 patients with incision infection,with an incidence rate of 9.4%.Divided into a modeling group of 500 cases at 7:3,inclu ding 48 cases of incision infection,with an incidence rate of 9.6%;There were 215 c ases in the validation group,including 19 cases of I-SSI,with an incidence of incisio n infection of 8.8%.There was no statistical difference(P>0.05)between the modelin g group and the validation group for each basic feature data.Univariate analysis show ed that 15 factors,including age,diabetes,hypoproteinemia,anemia,preoperative chem oradiotherapy history,postoperative serum albumin level,operation type,anesthesia AS A classification,operation time,incision length,intraoperative blood transfusion,anasto motic fistula,BMI,operation status and stoma,were associated with postoperative I-SS I in colorectal cancer patients.Logistic regression analysis showed that BMI ≥ 25kg/m2 with diabetes,hypoproteinemia,preoperative history of radiotherapy and chemotherap y,emergency surgery,stoma were independent risk factors for incision infection;Acco rding to the regression analysis results,the equation for predicting the risk of postoper ative incision infection in colorectal cancer is: Logit(P)=(-4.819)+0.997 × BMI+1.067× Diabetes+1.250 × Hypoalbuminemia+1.176×History of preoperative radiotherapy and chemotherapy+1.486 × Surgical status+1.074 × Create a stoma and visualize it in the form of a column chart.3.Validate the established risk prediction model for postoperative I-SSI in colorectal cancer,and the modeling group’s Hosmer Limeshow(H-L)test results show that χ2= 6.046,P=0.534,with no statistically significant difference(P>0.05).The validation group’s Hosmer Limeshow(H-L)test results showed that χ2= 9.941,P=0.192,with no statistically significant difference(P>0.05),indicating that there was no significant difference between the predicted values of the I-SSI risk prediction model and the actual observed values after colorectal cancer surgery.The model had a good fit and had a certain degree of reliability.The modeling group of this study: AUC under ROC curve=0.850,95% CI(0.797-0.903),sensitivity 70.8%,specificity 86.3%;The validation group had AUC=0.846,95% CI(0.751-0.941),sensitivity of 68.4%,and specificity of 88.3%;This indicates that the risk prediction model constructed in this study has good predictive effect and can correctly distinguish between postoperative incision infection and non incision infection in colorectal cancer patients.Conclusion1.Through literature review and expert meetings,this study identified a total of 24 risk factors related to postoperative I-SSI in colorectal cancer,including general basic information,past history,surgical conditions,and perioperative conditions,and developed a risk factor questionnaire.2.The established I-SSI risk prediction model after colorectal cancer surgery shows that BMI ≥ 25kg/m2,combined with diabetes,accompanied with hypoproteinemia,pre-operative history of radiotherapy and chemotherapy,emergency surgery,stoma are independent risk factors for incision infection,and the evaluation process is simple and clear through the nomogram.3.After verification,the risk prediction model has good fitting and discrimination,and has high predictive ability.This model provides a reference basis for medical staff to identify high-risk populations of I-SSI in the early stage.