Analysis Of Risk Factors Associated With Fever After Endoscopic Submucosal Dissection For Colorectal Tumors

Objective:To investigate fever and its associated risk factors after transendoscopic submucosal dissection(ESD)for colorectal tumors and to assess the risk of postoperative fever,with the aim of providing a basis for reducing the rate of postoperative fever and clinical management of patients by enhancing intraoperative and postoperative management.Methods:In this study,clinical and pathological data were retrospectively collected from 508 patients who were hospitalized in the Department of Gastroenterology of our hospital for ESD due to colorectal tumors and 62 patients who were hospitalized in the Department of Gastroenterology of our hospital for surgery due to early colorectal cancer between June 1,2019,and July 1,2022,using clinical retrospective analysis.The included ESD group patients were divided into febrile and normal groups according to whether they were febrile or not after surgery,and the data of both groups were statistically analyzed.The main indicators collected were:basic clinical conditions(age,sex,marital status,occupation,ethnicity,first symptoms,BMI),past history(history of smoking,history of alcohol consumption,concomitant hypertension,concomitant diabetes,concomitant hyperlipidemia,concomitant cardiovascular and cerebrovascular diseases,history of abdominal surgery),surgical conditions(surgeon qualifications,postoperative complications(bleeding or perforation),intraoperative antibiotic use,postoperative antibiotic(use of postoperative antibiotics,duration of postoperative fasting),pathology(lesion size,lesion location,histological type,vertical margin,nerve and vascular infiltration),hospitalization(duration of postoperative hospitalization,hospitalization cost),etc.Risk factors for postoperative fever in colorectal tumor ESD were investigated using univariate and multifactorial logistic regression analysis,and ROC curve analysis of the predictive value of combined predictors for postoperative fever in ESD,and a risk model for assessing postoperative fever was established.Finally,the included surgical group was also compared with the ESD group in terms of postoperative fever or not,postoperative fasting time,postoperative hospital stay,and hospital costs.Results:A total of 508 ESD study subjects were included in this study,including 52 cases in the febrile group and 456 cases in the normal group,with a post-ESD fever rate of approximately 10.2%(52/508).A univariate analysis showed statistically significant differences between the two groups in terms of age ≤65 or>65 years,lesion size>2 cm,postoperative complications(perforation or bleeding),intraoperative antibiotic use,postoperative antibiotic use,postoperative fasting time,postoperative hospital stay,hospital cost,and whether or not secondary endoscopy was performed(P<0.05).Multifactorial logistic regression analysis yielded that age(OR:1.96,95%CI:1.03-3.75,P<0.05),lesion size>2 cm(OR:2.05,95%CI:1.04-4.04,P<0.05),postoperative complications(OR:14.01,95%CI:2.97-66.16,P<0.05),and duration of postoperative fasting(OR:1.04,95%CI:1.03-1.06,P<0.05)were independent risk factors affecting postoperative fever after ESD.In addition,a joint predictor(L)model was developed based on a multifactorial analysis showing four independent risk factors affecting postoperative fever after ESD,with the model established as L=0.68*age+2.64*postoperative complications+0.04*postoperative fasting time+0.72*lesion size.By ROC curve analysis,the area under the curve of the combined predictors for postoperative fever in ESD was AUC=0.78(P<0.001,95%CI:0.70-0.86),with 7.14 as the best diagnostic value,sensitivity of 71%,and specificity of 74%.In contrast,the rate of postoperative fever in the included surgical group was as high as 96.8%(60/62),and the differences between the two data groups were statistically significant(P<0.05)by comparison with the ESD group in terms of the presence or absence of postoperative fever,duration of postoperative fasting,duration of postoperative hospitalization,and hospital costs.Conclusion:1.Postoperative fever after ESD is not uncommon in clinical practice,and its incidence is about 10.2%.2.Age,lesion size,postoperative complications(bleeding or perforation),and duration of postoperative fasting are independent risk factors for postoperative fever after ESD for colorectal tumors.3.ESD has more significant advantages over surgery in terms of whether postoperative fever,postoperative fasting time,postoperative hospitalization time,and hospitalization cost.