Construction And Validation Of The Risk Prediction Model Of Emergence Agitation In Patients With Abdominal Surgery

BackgroundEmergence agitation(EA),also known as emergence delirium or emergence excitement or inadequate emergence,is defined as a violent and fluctuating mental state change characterized by agitation,confusion,disorientation,and hyperactivity,is one of the common complications of the early emergence of general anesthesia.The incidence of emergence agitation is high in patients after abdominal surgery.Emergence agitation increases the risk for hemorrhages,self-extubation,injury,hemodynamic instability,and an increased incidence of postoperative complications.The construction of the risk prediction model of emergence agitation in patients with abdominal surgery will improve prevention strategies of emergence agitation,provide information for clinical decision-making,and ensure the safety of patients during general anesthesia.ObjectivesThis study aims to construct a risk prediction model of emergence agitation in patients with abdominal surgery and validate its application effectMethods1.Delphi method:According to the literature research and the retrospective study results,the entry pool of emergence agitation risk factors for patients undergoing abdominal surgery was preliminarily formulated,and the emergence agitation risk prediction index system for patients undergoing abdominal surgery was constructed through two rounds of expert consultation.2.The convenient sampling method was used to select 495 patients who underwent abdominal surgery in a third-class A hospital in Guangzhou from June to October 2022.According to whether emergence agitation occurred during the recovery period of general anesthesia,the patients were divided into emergence agitation group and non-emergence agitation group.Among them,347 patients are the model construction queue,and the logistic regression equation is used to build the emergence agitation risk prediction model for abdominal surgery patients,and 148 patients are the model validation queue to verify the prediction effect of the model.Results1.Delphi method:The effective recovery rates-of the two rounds of expert consultation questionnaires were 100%and 86.7%respectively.The expert authority coefficients of the two rounds of expert consultation questionnaires were 0.846 and 0.843,the average variation coefficients were 0.212 and 0.158,and the Kendall coefficients of concordance were 0.314 and 0.336,respectively.Finally,the risk prediction index system of emergence agitation in patients undergoing abdominal surgery with general anesthesia,including 5 primary indicators and 23 secondary indicators,was formed.2.Construction of risk prediction model of emergence agitation in patients with abdominal surgery:Significant indicators in univariate analysis of the model construction queue included the type of surgery(χ2=6.426,P=0.011),urinary catheter(χ2=10.861,P<0.001),cognitive impairment(Fisher,P=0.001),operation duration(χ2=5.54,P<0.063)and postoperative pain(χ2=10.706,P=0.001).The above indicators were included in multivariate logistic regression analysis,and it was concluded that the influencing factors of emergence agitation in patients undergoing abdominal surgery were the type of surgery(OR=0.533,P=0.041),urinary catheter(OR=2.631,P=0.002),cognitive impairment(OR=22.476,P=0.005)and postoperative pain(OR=2.697,P<0.001).The constructed logistic regression model is:Logit(P)=ln[p/(1-p)]=-1.037-0.63*the type of surgery+0.967*urinary catheter+3.112*cognitive impairment+0.992*postoperative pain.3.Verification of the risk prediction model of emergence agitation in patients with abdominal surgery:The Hosmer-Lemeshow goodness-of-fit test was nonsignificant(P=0.235),indicating that the model exhibited a good fit.The area under the ROC curve in development and validation phase was 0.721(95%CI,0.660-0.782)and 0.751(95%CI,0.649-0.853),the specificity is 87.39%,the sensitivity is 67.57%,and the accuracy is 82.43%.ConclusionsThe independent risk factors affecting the occurrence of emergence agitation in patients with abdominal surgery include urinary catheter,cognitive impairment,and postoperative pain.And minimally invasive surgery is an independent protective factor.The risk prediction model of emergence agitation in patients with abdominal surgery has a good prediction effect which can provide guidance for doctors and nurses in the Postanaesthesia Care Unit to effectively predict and screen emergence agitation in patients with abdominal surgery.