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, 陈心足, 等. 胃癌术后肺部感染发生因素及围手术期干预措施. 中华胃肠外科杂志, 2021, 24(2): 185-190.
3.	中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南 (2018年版). 中华结核和呼吸杂志, 2018, 41(4): 255-280.
4.	吴秀文, 任建安. 中国腹腔感染诊治指南 (2019版). 中国实用外科杂志, 2020, 40(1): 1-16.
5.	中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
6.	尿路感染诊断与治疗中国专家共识编写组. 尿路感染诊断与治疗中国专家共识 (2015版)—尿路感染抗菌药物选择策略及特殊类型尿路感染的治疗建议. 中华泌尿外科杂志, 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, 王盼兴, 朱梦珂, 等. 腹腔镜辅助胃癌根治术后发生低蛋白血症的多因素分析及其对近期临床结局的影响. 中国普外基础与临床杂志, 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, 唐学虎, 曾棒, 等. 行电视胸腔镜辅助手术的老年食管癌患者心血管不良反应发生风险的影响因素及列线图模型构建. 中国癌症杂志, 2023, 33(3): 282-287.
19.	陈明芬, 范雪梅, 刘颖, 等. 术前衰弱评估与老年结直肠癌患者术后并发症相关性. 中国老年学杂志, 2022, 42(20): 5133-5136.
20.	陈晓军, 孙爱华, 吴颜丹, 等. 全身麻醉患者术后医院感染病原学及风险预测模型构建. 中华医院感染学杂志, 2023(18): 2785-2789.
21.	刘芯妤, 彭丽华, 曾莉怡. ASA评分与手术时间在结直肠癌患者手术部位感染风险评估中的作用. 中国感染控制杂志, 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, Møller AM, Pedersen B, et al. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev, 2012(7): CD008343.
24.	Egholm JW, Pedersen B, Møller 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, 陈心足, 等. 胃癌术后肺部感染发生因素及围手术期干预措施. 中华胃肠外科杂志, 2021, 24(2): 185-190.
3. 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南 (2018年版). 中华结核和呼吸杂志, 2018, 41(4): 255-280.
4. 吴秀文, 任建安. 中国腹腔感染诊治指南 (2019版). 中国实用外科杂志, 2020, 40(1): 1-16.
5. 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
6. 尿路感染诊断与治疗中国专家共识编写组. 尿路感染诊断与治疗中国专家共识 (2015版)—尿路感染抗菌药物选择策略及特殊类型尿路感染的治疗建议. 中华泌尿外科杂志, 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, 王盼兴, 朱梦珂, 等. 腹腔镜辅助胃癌根治术后发生低蛋白血症的多因素分析及其对近期临床结局的影响. 中国普外基础与临床杂志, 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, 唐学虎, 曾棒, 等. 行电视胸腔镜辅助手术的老年食管癌患者心血管不良反应发生风险的影响因素及列线图模型构建. 中国癌症杂志, 2023, 33(3): 282-287.
19. 陈明芬, 范雪梅, 刘颖, 等. 术前衰弱评估与老年结直肠癌患者术后并发症相关性. 中国老年学杂志, 2022, 42(20): 5133-5136.
20. 陈晓军, 孙爱华, 吴颜丹, 等. 全身麻醉患者术后医院感染病原学及风险预测模型构建. 中华医院感染学杂志, 2023(18): 2785-2789.
21. 刘芯妤, 彭丽华, 曾莉怡. ASA评分与手术时间在结直肠癌患者手术部位感染风险评估中的作用. 中国感染控制杂志, 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, Møller AM, Pedersen B, et al. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev, 2012(7): CD008343.
24. Egholm JW, Pedersen B, Møller 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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