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Development of a nomogram for postoperative surgical site infections in patients undergoing bowel resection for Crohn's disease - 17/09/24

Doi : 10.1016/j.clinre.2024.102462 
Boxuan Lu a, Meiling Zhang a, Zhihui Wang a, Wenhao Zhang a, Yinxiao Lu a, Jianfeng Gong b, Zhifang Wu a, , Qing Ji a,
a Department of Anesthesiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, PR China 
b Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, PR China 

Correspondence author at: Department of Anesthesiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305# Zhongshan East Road, Nanjing, Jiangsu Province 210016, PR China.Department of AnesthesiologyNanjing Jinling HospitalAffiliated Hospital of Medical School, Nanjing University305# Zhongshan East RoadNanjingJiangsu Province210016PR China⁎⁎Zhifang Wu, Department of Anesthesiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305# Zhongshan East Road, Nanjing, Jiangsu Province 210016, PR China.Department of AnesthesiologyNanjing Jinling HospitalAffiliated Hospital of Medical School, Nanjing University305# Zhongshan East RoadNanjingJiangsu Province210016PR China

Highlights

A new nomogram for predicting SSI in Crohn's disease patients.
Increased blood loss, remaining lesions, and previous intestinal resection raise SSI risk.
Patients with Montreal classification A1 and L2 are prone to SSI.
Corticosteroid use, female, and higher neutrophil count are risk factors for SSI.
Undergoing strictureplasty is a protective factor against SSI.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Surgical site infection (SSI) is a significant concern due to its potential to cause delayed wound healing and prolonged hospital stays. This study aims to develop a predictive model in patients with Crohn's disease.

Methods

We conducted single-factor and multi-factor logistic regression analyses to identify risk factors, resulting in the development of a logistic regression model and the creation of a nomogram. The model's effect was validated by employing enhanced bootstrap resampling techniques, calibration curves, and DCA curves. Finally, we investigated the risk factors for wall and intra-abdominal infections separately.

Results

90 of 675 patients (13.3 %) developed SSI. Several independent risk factors for SSI were identified, including higher postoperative day one neutrophil count (p = 0.033), higher relative blood loss (p = 0.018), female gender (p = 0.021), preoperative corticosteroid use (p = 0.007), Montreal classification A1 and L2 (p < 0.05), previous intestinal resection (p = 0.017), and remaining lesions (p = 0.015). Additionally, undergoing strictureplasty (p = 0.041) is a protective factor against SSI. These nine variables were used to develop an SSI prediction model presented as a nomogram. The model demonstrated strong discrimination (adjusted C-statistic=0.709, 95 % CI: 0.659∼0.757) and precise calibration. The decision curve showed that the nomogram was clinically effective within a probability threshold range of 3 % to 54 %. Further subgroup analysis revealed distinct risk factors for wall infections and intra-abdominal infections.

Conclusion

We established a new predictive model, which can guide the prevention and postoperative care of SSI after Crohn's disease bowel resection surgery to minimize its occurrence rate.

Le texte complet de cet article est disponible en PDF.

Keywords : Crohn's disease, Nomogram, Risk factor, Surgical wound infection

Abbreviations : CD, SSI, EN, PN, DCA


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Vol 48 - N° 8

Article 102462- octobre 2024 Retour au numéro
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