The Construction Of A Nomogram For Predicting The Postoperative Hemorrhage Of Laparoscopic Pancreaticoduodenectomy

Objective:To explore the independent risk factors of postoperative hemorrhage of laparoscopic pancreaticoduodenectomy(LPD)and construct a nomogram to achieve individualized risk prediction.Methods:Clinical data of 218 patients who underwent LPD in the Hepatobiliary Department of the Second Hospital of Hebei Medical University from January2018 to September 2020 were retrospectively analyzed.Patients were divided into two groups: hemorrhage group and no hemorrhage group according to whether they had postoperative hemorrhage or not.The clinical information of patients was statistically analyzed,and the risk factors of postoperative hemorrhage of LPD were analyzed by univariate and multivariate Logistic regression.A nomogram was established based on the results of multivariate logistic regression analysis.The area under the curve(AUC)of the receiver operating characteristic curve(ROC)and the calibration curve were used to evaluate the nomogram,and the Bootstrap method was used for internal validation.Results:Multivariate logistic regression analysis revealed that age,operative time,intraoperative blood loss,postoperative pancreatic fistula grade C and abdominal infection were independent risk factors for postoperative hemorrhage of LPD(P < 0.05).These 5 independent risk factors were selected to construct a nomogram to predict the risk of postoperative hemorrhage of LPD.The AUC of this model was 0.994,95%confidence interval(CI)was0.987-1,P < 0.001.The C-index was 0.994.The actual curve of the nomogarm was very close to the ideal curve,and the prediction ability of the model is pretty good.The mean absolute error of 1000 replicated sample was1.2%.Conclusions:The construction of the nomogram of postoperative hemorrhage of LPD realizes the individualized risk prediction,and increase the vigilance of clinicians to postoperative bleeding,and it has value in communication between patients and clinicians.