预测口腔内窥镜肌切开术后医院介入治疗需求的风险评分系统。

Hirofumi Abe, Shinwa Tanaka, Hiroya Sakaguchi, Chise Ueda, Hitomi Hori, Tatsuya Nakai, Tetsuya Yoshizaki, Fumiaki Kawara, Takashi Toyonaga, Masato Kinoshita, Satoshi Urakami, Shinya Hoki, Hiroshi Tanabe, Yuzo Kodama
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引用次数: 0

摘要

目的:内镜治疗后需要住院介入治疗(HIC)的患者的早期识别对于优化术后住院时间非常重要。我们旨在开发并验证一套风险评分系统,用于预测口腔内镜下肌切开术(POEM)患者的 HIC:本研究纳入了2015年4月至2023年3月期间在我院接受POEM手术的食管运动障碍患者。HIC定义为以下任何一种情况:禁食以休息胃肠道以控制不良事件(AE);静脉给药,如抗生素和输血;内窥镜、放射学和外科干预;重症监护室管理;或其他危及生命的事件。采用多变量逻辑回归法开发了一套用于预测术后第1天(POD)后HIC的风险评分系统,并通过引导和决策曲线分析进行了内部验证:在 589 名患者中,有 50 人(8.5%)在 POD1 后出现 HIC。该风险评分系统可预测 POD1 后的 HIC,并为决定出院提供有用信息。
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Risk-scoring system predicting need for hospital-specific interventional care after peroral endoscopic myotomy.

Objectives: Early identification of patients needing hospital-specific interventional care (HIC) following endoscopic treatment is valuable for optimizing postoperative hospital stays. We aimed to develop and validate a risk-scoring system for predicting HIC in patients who underwent peroral endoscopic myotomy (POEM).

Methods: This study included patients with esophageal motility disorders who underwent POEM at our hospital between April 2015 and March 2023. HIC was defined as any of the following situations: fasting for gastrointestinal rest to manage adverse events (AEs); intravenous administration of medications such as antibiotics and blood transfusion; endoscopic, radiologic, and surgical interventions; intensive care unit management; or other life-threatening events. A risk-scoring system for predicting HIC after postoperative day (POD) 1 was developed using multivariable logistic regression and was internally validated using bootstrapping and decision curve analysis.

Results: Of the 589 patients, 50 (8.5%) experienced HIC after POD1. Risk scores were assigned for four factors as follows: age (0 points for <70 years, 1 point for 70-79 years, 2 points for ≥80 years), preoperative prognostic nutritional index (0 points for >45, 1 point for 40-45, 4 points for <40), postoperative surgical site AEs on second-look endoscopy (7 points), and postoperative pneumonia on chest radiography (6 points). The discriminative ability (concordance statistics, 0.85; 95% confidence interval, 0.78-0.91) and calibration (slope 1.00; 0.74-1.28) were satisfactory. The decision curve analysis demonstrated its clinical usefulness.

Conclusion: This risk-scoring system can predict the HIC after POD1 and provide useful information for determining discharge.

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