Risk Prediction Model Of Abdominal Pain And Diarrhea In Patients With Gallstone After LC Based On LASSO Regression:A Retrospective Cohort Study

Objective: Cholecystectomy is the main treatment for gallstones at present,but some patients still have persistent or new symptoms after surgery,mainly including abdominal pain and diarrhea,which importantly affects the quality of life of patients.However,it is difficult to determine the risk factors of its occurrence,and there is a lack of risk prediction models to accurately predict its occurrence.The purpose of this study is to establish and validate a nomograph model based on simple preoperative characteristics of patients to predict the risk probability of abdominal pain and diarrhea after laparoscopic cholecystectomy(LC)in patients with simple gallstones.Methods: We retrospectively and continuously included 1204 patients with simple gallstones who underwent LC in the Affiliated Hospital of Southwest Medical University from November 2020 to November 2021.The preoperative characteristics of patients were collected by reviewing the electronic medical records.The patient data from November 2020 to August 2021 is used as the training cohort(843 cases),and the patient data from September 2021 to November 2021 is used as the validation cohort(361 cases).In the training cohort,the least absolute shrinkage and selection operator(LASSO)regression analysis and multifactor logistic regression analysis were used to determine the risk factors of long-term postoperative abdominal pain and diarrhea in patients with gallstones.Then,based on the selected risk factors,the risk prediction models of postoperative abdominal pain and diarrhea were established respectively,and the prediction models were visualized by the nomogram.The area under curve(AUC),calibration curve and clinical decision curve analysis(DCA)were used to evaluate the predictive effectiveness of the prediction model in the training and validation cohort.Results: After LASSO regression and multivariate logistic regression analysis,it was determined that the patient’s gender,history of abdominal surgery,daytime surgery,preoperative pain,radiation pain,nausea and vomiting,and preoperative pain are predictive factors of long-term postoperative abdominal pain.Further using the seven prediction factors to build the prediction model.The AUC of the training cohort and the validation cohort are 0.791 and 0.716,respectively.In addition,the age,sex,alcohol consumption,preoperative pain and the number of stones are determined as the predictive factors of long-term postoperative diarrhea.Based on these predictive factors,the prediction model was built.The AUC of the training cohort and the validation cohort are 0.869 and0.839,respectively.After the assessment of calibration and clinical decision curve,both models have good predictive ability and clinical applicability.Conclusion: The prediction model based on simple preoperative characteristics can stratify the risk of postoperative abdominal pain and diarrhea in patients with gallstone after LC,thus helping clinicians determine which patients can better benefit from LC.