Development of a nomogram for predicting the probability of postoperative delirium in patients undergoing free flap reconstruction for head and neck cancer
Development of a nomogram for predicting the probability of postoperative delirium in patients undergoing free flap reconstruction for head and neck cancer
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DOI：
10.1016/j.ejso.2016.09.018
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发表时间：
2017-04-01
期刊：
影响因子：
3.8
通讯作者：
Chung, M. K.
中科院分区：
文献类型：
--
作者：
Choi, N. Y.;Kim, E. H.;Chung, M. K.
目的：建立预测头颈癌消融重建手术患者术后谵妄（POD）的nomogram。方法：对341例患者进行回顾性分析，比较谵妄组（n = 89）和非谵妄组（n = 252）术前、术中、术后的临床变量。采用多元逻辑回归、受试者工作特征曲线和曲线下面积（AUC）生成并检验nomogram，并通过10倍交叉验证（CV）程序对nomogram进行评价。结果：在单因素和多因素分析中，年龄、精神障碍史、婚姻状况、术前疼痛数值评定量表、ASA分级和ICU住院时间被确定为显著危险因素。利用这些因素建立预测POD的nomogram，其敏感性为61.8%，特异性为75.4%，PPV为47.0%，NPV为84.8% （Youden’s index = 0.372）。在10倍交叉验证集中，对应值分别为44.9%、84.1%、50.0%和81.2%（约登指数为0.337）。两组间AUC具有可比性（0.7407和0.6898）。结论：所提出的nomogram对接受大手术的头颈癌患者POD风险具有公平的判别能力。(C) 2016爱思唯尔有限公司，BASO -癌症外科协会和欧洲外科肿瘤学会。版权所有。
Purpose: To develop nomogram for prediction of postoperative delirium (POD) in patients undergoing ablative and reconstruction surgery for head and neck cancer.Methods: Total 341 patients were retrospectively analyzed, and clinical variables in preoperative, intraoperative and postoperative periods were compared between delirium group (n = 89) and non-delirium group (n = 252). Multivariate logistic regression, receiver operating characteristics curve, and area under the curve (AUC) were used to generate and test a nomogram, which performance was evaluated by 10-fold cross validation (CV) procedure.Results: In univariate and multivariate analysis, age, history of psychiatric disorder, marital status, preoperative numeric rating scale for pain, ASA classification, and ICU stay period were identified as significant risk factors. Using these factors, nomogram for predicting the POD was developed and it showed sensitivity of 61.8%, specificity of 75.4%, PPV of 47.0%, and NPV of 84.8% (Youden's index of 0.372). In 10-fold cross validation set, corresponding values were 44.9%, 84.1%, 50.0% and 81.2% (Youden's index of 0.337). AUC was comparable between two sets (0.7407 and 0.6898).Conclusions: Proposed nomogram showed fair discriminative power for POD risk in head and neck cancer patients undergoing major surgery. (C) 2016 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.