Analysis Of Related Factors And Construction Of Prediction Model For Clinical Enterostomy Recovery

Background:There are many reasons for enterostomy,the most common is prophylactic terminal ileostomy for radical resection of rectal tumors,and colostomy for various reasons.Theoretically,as long as the anal operation is preserved,there is hope for the closure of the stoma.But in fact,the existence of many factors affects the feasibility of stoma closure,such as the operation method,postoperative recovery,and the basic condition of the patient.All of these may affect the feasibility of stoma restoration in the future.The non-permanent stoma cannot be closed due to various reasons,which brings a great psychological gap to the patient,seriously reduces the quality of life of the patient,and increases the financial burden on the patient’s family.In addition,this also brings distrust of patients to medical care,which will reduce the social evaluation of medical care.Objective: The purpose of this study is to fully understand the perioperative conditions of patients,analyze the influence of various factors on the feasibility of subsequent enterostomy closure during the perioperative period and before discharge,and establish a clinical model to predict the feasibility of enterostomy closure.This model provides medical evidence for the customization of personalized treatment after enterostomy and communication with patients.Methods: The data of patients with enterostomy in our hospital(Gastrointestinal Surgery,Affiliated Hospital of Southwest Medical University)were collected retrospectively.The time limit is from November 1,2018 until November 30,2022.The subjects were patients who underwent enterostomy for the treatment of colorectal diseases in our hospital.The follow-up time was1 year after stoma operation,and the outcome index was whether the stoma was closed or not.The general data of patients were compared and single factor logistic regression analysis was performed.Parameter collinearity was tested and parameters were screened for multivariate logistic regression analysis.Examine the model resulting from multivariate logistic analysis.Draw a nomogram to visualize the model.Results: Among the 168 patients in the stoma group,the stoma was not closed in 34 patients.Of the 128 patients in the tumor group,the stoma was not closed in 25 patients.In the stoma group,BMI(P<0.01),operation time(P<0.01),preoperative albumin(P<0.01),stoma location(P=0.01),preoperative lymphocyte count(P=0.02),and surgical methods(laparoscopic and laparotomy,P=0.05)were statistically different between the stoma closed group and the non-closed group.In univariate logistic regression analysis,BMI(OR=1.21,95%CI=1.068,1.374,P<0.01),operation duration(OR=1.007,95%CI=1.002,1.012,P<0.01),preoperative albumin(OR=1.09,95%CI=1.02,1.17,P=0.01),stoma location(OR=0.35,95%CI=0.16,0.75,P<0.01),surgical method(laparoscopic and laparotomy,OR=0.43,95%CI=0.20,0.92,P=0.03)were the influencing factors of stoma closure.In multiple regression analysis,stoma location(OR=0.25,95%CI=0.10,0.61,P<0.01),BMI(OR=1.24,95%CI=1.08,1.43,P<0.01),preoperative neutrophil count(OR=0.88,95%CI=0.77,0.99,P=0.04),preoperative neutrophil percentage(OR=1.06,95%CI=1.01,1.11,P=0.02),preoperative albumin level(OR=1.08,95%CI=0.99,1.17,P=0.08)were independent factors affecting the feasibility of stoma closure.In the tumor group,stoma position(P<0.01),preoperative lymphocyte count(P<0.01),tumor volume(P<0.01),operation time(P=0.01),preoperative albumin level(P=0.01),preoperative hemoglobin level(P=0.03),postoperative hemoglobin level(P=0.04),preoperative neutrophil count(P=0.05),CEA(P=0.05)were statistically different between the stoma closed group and the non-closed group.In the single factor logistic regression analysis showed that stoma location(OR=0.16,95%CI=0.06,0.40,P<0.01),tumor volume(OR=0.99,95%CI=0.98,1.00,P=0.04),operation time(OR=1.008,95%CI=1.002,1.014,P=0.02),preoperative albumin level(OR=1.11,95%CI=1.01,1.22,P=0.03),preoperative hemoglobin level(OR=1.02,95%CI=1.00,1.04,P=0.03),postoperative hemoglobin level(OR=1.03,95%CI=1.00,1.05,P=0.04),prognostic staging(OR=0.50,95%CI=0.28,0.91,P=0.02),surgical method(laparoscopic and open,OR=0.39,95%CI=0.16,0.96,P=0.04),intraoperative blood loss(OR=0.9912,95%CI=0.9834,0.9977,P=0.02)were influencing factors of stoma closure in cancer patients.Multiple regression analysis showed that gender(OR=1.161,95%CI=0.987,1.335,P=0.035),history of abdominal surgery(OR=0.848,95%CI=0.726,0.992,P=0.039),tumor prognosis stage(OR=0.015,95%CI=0.002,0.085,P<0.001),chemotherapy(OR=1.151,95%CI=1.004,1.320,P=0.044),stoma location(OR=0.67,95%CI=0.57,0.79,P<0.01),BMI(OR=1.021,95%CI=1.004,1.039,P=0.016),preoperative neutrophil percentage(OR=1.005,95%CI=1.000,1.011,P=0.051),postoperative Hb level(OR=1.006,95%CI=1.002,1.010,P=0.007),postoperative albumin level(OR=0.972,95%CI=0.956,0.988,P=0.001),the intraoperative blood loss(OR=0.9993,95%CI=0.9985,1.0001,P=0.089)were independent influencing factors of stoma closure in cancer patients.Conclusion: The model constructed by stoma location,BMI,preoperative neutrophil number,preoperative neutrophil percentage,and preoperative albumin level has good accuracy and consistency in predicting the closure feasibility of terminal ileostomy and colostomy.The model constructed by gender,abdominal surgery history,tumor prognosis stage,chemotherapy,stoma location,BMI,preoperative neutrophil percentage,postoperative Hb level,postoperative albumin level,and intraoperative blood loss,to predict the feasibility of stoma closure in tumor patients has good consistency and accuracy.For cancer patients,although two models can be used to predict the feasibility of stoma closure,using model 2 to predict the probability of stoma closure in patients to determine whether to perform medical intervention may obtain greater net benefits.