Analysis of risk factor and establishment of prediction modeling for infectious complications after radical gastrectomy for gastric cancer: a retrospective cohort study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Zhekui ^1,2 , HAN Xiaofan ^1,3 , WANG Zezheng ^1,3 , MA Wenxing ^1,3 ,  DUAN Xianglong ^1,2,3

1. The Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an 710068, P. R. China;
2. Xi’an Medicine University, Xi’an 710021, P. R. China;
3. Medical School of Yan’an University, Yan’an, Shaanxi 716000, P. R. China;

Corresponding?author：

DUAN Xianglong, Email: duanxl@21cn.com

Keywords：

gastric cancer; radical gastrectomy; infectious complication; risk factor; Nomogram

DOI：

10.7507/1007-9424.202309017

Video：

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Objective To investigate the risk factors affecting the occurrence of infectious complications after radical gastrectomy for gastric cancer, and to establish a risk prediction Nomogram model. Methods The clinicopathologic data of 429 primary gastric cancer patients who underwent radical resection for gastric cancer at the Second Department of General Surgery of Shaanxi Provincial People’s Hospital between January 2018 and December 2020 were retrospectively collected to explore the influencing factors of infectious complications using multivariate logistic regression analyses, and to construct a prediction model based on the results of the multivariate analysis, and then to further validate the differentiation, consistency, and clinical utility of the model. Results Of the 429 patients, infectious complications occurred in 86 cases (20.05%), including 53 cases (12.35%) of pulmonary infections, 16 cases (3.73%) of abdominal infections, 7 cases (1.63%) of incision infections, and 10 cases (2.33%) of urinary tract infections. The results of multivariate logistic analysis showed that low prognostic nutritional index [OR=0.951, 95%CI (0.905, 0.999), P=0.044], long surgery time [OR=1.274, 95%CI (1.069, 1.518), P=0.007], American Society of Anesthesiologists physical status classification (ASA) grade Ⅲ–Ⅳ [OR=9.607, 95%CI (4.484, 20.584), P＜0.001] and alcohol use [OR=3.116, 95%CI (1.696, 5.726), P＜0.001] were independent risk factors for the occurrence of infectious complications, and a Nomogram model was established based on these factors, with an area under the ROC of 0.802 [95%CI (0.746, 0.858)]; the calibration curves showed that the probability of occurrence of infectious complications after radical gastrectomy predicted by the Nomogram was in good agreement with the actual results; the decision curve analysis showed that the Nomogram model could obtain clinical benefits in a wide range of thresholds and had good practicality.Conclusions Clinicians need to pay attention to the perioperative management of gastric cancer patients, fully assess the patients’ own conditions through the prediction model established by prognostic nutritional index, surgery time, ASA grade and alcohol use, and take targeted interventions for the patients with higher risks, in order to reduce the risk of postoperative infectious complications.

Citation： LIU Zhekui, HAN Xiaofan, WANG Zezheng, MA Wenxing, DUAN Xianglong. Analysis of risk factor and establishment of prediction modeling for infectious complications after radical gastrectomy for gastric cancer: a retrospective cohort study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(2): 218-224. doi: 10.7507/1007-9424.202309017 Copy

1.	Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China, 2016. Journal of the National Cancer Center, 2022, 2(1): 1-9.
2.	白丹, 向雯, 陳心足, 等. 胃癌術后肺部感染發生因素及圍手術期干預措施. 中華胃腸外科雜志, 2021, 24(2): 185-190.
3.	中華醫學會呼吸病學分會感染學組. 中國成人醫院獲得性肺炎與呼吸機相關性肺炎診斷和治療指南 (2018年版). 中華結核和呼吸雜志, 2018, 41(4): 255-280.
4.	吳秀文, 任建安. 中國腹腔感染診治指南 (2019版). 中國實用外科雜志, 2020, 40(1): 1-16.
5.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
6.	尿路感染診斷與治療中國專家共識編寫組. 尿路感染診斷與治療中國專家共識 (2015版)—尿路感染抗菌藥物選擇策略及特殊類型尿路感染的治療建議. 中華泌尿外科雜志, 2015, 36(4): 245-248.
7.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 2017, 20(1): 1-19.
8.	Martin AN, Das D, Turrentine FE, et al. Morbidity and mortality after gastrectomy: identification of modifiable risk factors. J Gastrointest Surg, 2016, 20(9): 1554-1564.
9.	Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: a meta-analysis. Eur J Surg Oncol, 2016, 42(8): 1176-1182.
10.	Ai S, Sun F, Liu Z, et al. Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. ANZ J Surg, 2019, 89(7-8): E297-E301.
11.	魏星星, 王盼興, 朱夢珂, 等. 腹腔鏡輔助胃癌根治術后發生低蛋白血癥的多因素分析及其對近期臨床結局的影響. 中國普外基礎與臨床雜志, 2022, 29(11): 1482-1487.
12.	Tsujiura M, Yamamoto A, Imaoka H, et al. Clinical utility of lymphocyte to C-reactive protein ratio in predicting survival and postoperative complication for esophago-gastric junction cancer. Surg Oncol, 2022, 44: 101842. doi: 10.1016/j.suronc.2022.101842.
13.	Xiao Y, Wei G, Ma M, et al. Association among prognostic nutritional index, post-operative infection and prognosis of stage Ⅱ/Ⅲ gastric cancer patients following radical gastrectomy. Eur J Clin Nutr, 2022, 76(10): 1449-1456.
14.	Xishan Z, Ye Z, Feiyan M, et al. The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy. Sci Rep, 2020, 10(1): 17373. doi: 10.1038/s41598-020-74525-8.
15.	Cheng H, Chen BP, Soleas IM, et al. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect (Larchmt), 2017, 18(6): 722-735.
16.	Wang X, Yao Y, Qian H, et al. Longer operating time during gastrectomy has adverse effects on short-term surgical outcomes. J Surg Res, 2019, 243: 151-159.
17.	Shibasaki S, Suda K, Nakauchi M, et al. Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: a single-center, retrospective and propensity score-matched analysis. World J Gastroenterol, 2020, 26(11): 1172-1184.
18.	李峰, 唐學虎, 曾棒, 等. 行電視胸腔鏡輔助手術的老年食管癌患者心血管不良反應發生風險的影響因素及列線圖模型構建. 中國癌癥雜志, 2023, 33(3): 282-287.
19.	陳明芬, 范雪梅, 劉穎, 等. 術前衰弱評估與老年結直腸癌患者術后并發癥相關性. 中國老年學雜志, 2022, 42(20): 5133-5136.
20.	陳曉軍, 孫愛華, 吳顏丹, 等. 全身麻醉患者術后醫院感染病原學及風險預測模型構建. 中華醫院感染學雜志, 2023(18): 2785-2789.
21.	劉芯妤, 彭麗華, 曾莉怡. ASA評分與手術時間在結直腸癌患者手術部位感染風險評估中的作用. 中國感染控制雜志, 2021, 20(12): 1144-1148.
22.	Tonnesen H, Kehlet H. Preoperative alcoholism and postoperative morbidity. Br J Surg, 1999, 86(7): 869-874.
23.	Oppedal K, M?ller AM, Pedersen B, et al. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev, 2012(7): CD008343.
24.	Egholm JW, Pedersen B, M?ller AM, et al. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database Syst Rev, 2018, 11(11): CD008343.

1. Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China, 2016. Journal of the National Cancer Center, 2022, 2(1): 1-9.
2. 白丹, 向雯, 陳心足, 等. 胃癌術后肺部感染發生因素及圍手術期干預措施. 中華胃腸外科雜志, 2021, 24(2): 185-190.
3. 中華醫學會呼吸病學分會感染學組. 中國成人醫院獲得性肺炎與呼吸機相關性肺炎診斷和治療指南 (2018年版). 中華結核和呼吸雜志, 2018, 41(4): 255-280.
4. 吳秀文, 任建安. 中國腹腔感染診治指南 (2019版). 中國實用外科雜志, 2020, 40(1): 1-16.
5. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
6. 尿路感染診斷與治療中國專家共識編寫組. 尿路感染診斷與治療中國專家共識 (2015版)—尿路感染抗菌藥物選擇策略及特殊類型尿路感染的治療建議. 中華泌尿外科雜志, 2015, 36(4): 245-248.
7. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 2017, 20(1): 1-19.
8. Martin AN, Das D, Turrentine FE, et al. Morbidity and mortality after gastrectomy: identification of modifiable risk factors. J Gastrointest Surg, 2016, 20(9): 1554-1564.
9. Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: a meta-analysis. Eur J Surg Oncol, 2016, 42(8): 1176-1182.
10. Ai S, Sun F, Liu Z, et al. Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. ANZ J Surg, 2019, 89(7-8): E297-E301.
11. 魏星星, 王盼興, 朱夢珂, 等. 腹腔鏡輔助胃癌根治術后發生低蛋白血癥的多因素分析及其對近期臨床結局的影響. 中國普外基礎與臨床雜志, 2022, 29(11): 1482-1487.
12. Tsujiura M, Yamamoto A, Imaoka H, et al. Clinical utility of lymphocyte to C-reactive protein ratio in predicting survival and postoperative complication for esophago-gastric junction cancer. Surg Oncol, 2022, 44: 101842. doi: 10.1016/j.suronc.2022.101842.
13. Xiao Y, Wei G, Ma M, et al. Association among prognostic nutritional index, post-operative infection and prognosis of stage Ⅱ/Ⅲ gastric cancer patients following radical gastrectomy. Eur J Clin Nutr, 2022, 76(10): 1449-1456.
14. Xishan Z, Ye Z, Feiyan M, et al. The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy. Sci Rep, 2020, 10(1): 17373. doi: 10.1038/s41598-020-74525-8.
15. Cheng H, Chen BP, Soleas IM, et al. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect (Larchmt), 2017, 18(6): 722-735.
16. Wang X, Yao Y, Qian H, et al. Longer operating time during gastrectomy has adverse effects on short-term surgical outcomes. J Surg Res, 2019, 243: 151-159.
17. Shibasaki S, Suda K, Nakauchi M, et al. Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: a single-center, retrospective and propensity score-matched analysis. World J Gastroenterol, 2020, 26(11): 1172-1184.
18. 李峰, 唐學虎, 曾棒, 等. 行電視胸腔鏡輔助手術的老年食管癌患者心血管不良反應發生風險的影響因素及列線圖模型構建. 中國癌癥雜志, 2023, 33(3): 282-287.
19. 陳明芬, 范雪梅, 劉穎, 等. 術前衰弱評估與老年結直腸癌患者術后并發癥相關性. 中國老年學雜志, 2022, 42(20): 5133-5136.
20. 陳曉軍, 孫愛華, 吳顏丹, 等. 全身麻醉患者術后醫院感染病原學及風險預測模型構建. 中華醫院感染學雜志, 2023(18): 2785-2789.
21. 劉芯妤, 彭麗華, 曾莉怡. ASA評分與手術時間在結直腸癌患者手術部位感染風險評估中的作用. 中國感染控制雜志, 2021, 20(12): 1144-1148.
22. Tonnesen H, Kehlet H. Preoperative alcoholism and postoperative morbidity. Br J Surg, 1999, 86(7): 869-874.
23. Oppedal K, M?ller AM, Pedersen B, et al. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev, 2012(7): CD008343.
24. Egholm JW, Pedersen B, M?ller AM, et al. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database Syst Rev, 2018, 11(11): CD008343.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of risk factor and establishment of prediction modeling for infectious complications after radical gastrectomy for gastric cancer: a retrospective cohort study

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