刘静静 1魏平珠 2罗成 3俞许超 4王宏超 5吴天艺1
作者信息
- 1. 上海交通大学医学院附属瑞金医院普通外科,胰腺疾病诊疗中心,上海 200025
- 2. 福州大学附属省立医院肝胆胰外科,福建 福州 350001
- 3. 贵州医科大学第二附属医院肝胆胰外科,贵州 贵阳 550004
- 4. 浙江省诸暨市人民医院重症医学科,浙江 诸暨 322200
- 5. 山东省立医院菏泽医院肝胆外科,山东 菏泽 274000
- 折叠
摘要
Abstract
Objective To develop a predictive model for postoperative delirium(POD)after radical surgery in elderly patients with pancreatic cancer,thereby providing a practical basis for the early identification and prevention of POD occurrence.Methods Data were retrospectively and consecutively collected from 202 elderly patients who underwent radical surgery for pancreatic cancer at Ruijin Hospital,Shanghai,from January 2025 to June 2025.These patients were included in the modeling group based on inclusion and exclusion criteria.Within 7 days after surgery,trained nursing staff used the confusion assessment method(CAM)daily to assess the occurrence of POD.The modeling group was further divided into delirium and non-delirium subgroups according to the occurrence of POD.Clinical characteristics of both groups were compared,and univariate analysis was used to identify risk factors for POD.Multivariable logistic regression analysis was performed to determine the partial regression coefficients of independent risk factors and construct a predic-tive model.Model performance was evaluated using the Hosmer-Lemeshow(H-L)test and the area under the curve(AUC)of the receiver operating characteristic(ROC).Additionally,101 patients who underwent the same type of surgery during the same period and met the same inclusion criteria,including 10 with delirium and 91 without,were selected as the valida-tion group to assess the predictive performance of the model.Results The analysis of risk factors associated with POD revealed significant differences in age,APACHE-Ⅱ score,intraoperative blood loss,diabetes,and preoperative sleep dis-turbance between the delirium and non-delirium groups(P<0.05).Logistic regression analysis identified age,APACHE-Ⅱscore,intraoperative blood loss,diabetes,and preoperative sleep disturbance as independent risk factors for POD(P<0.05).Based on the regression analysis,the predictive model was constructed by multiplying each independent risk factor by its corresponding regression coefficient:P=e×/(1+e×)×100%,where e is the base of the natural logarithm and x=-13.959+0.106×age+0.357×APACHE-Ⅱ score+0.003×intraoperative blood loss+1.306×diabetes status+1.785×preopera-tive sleep disturbance status.The AUC of the predictive model was 0.893(95%CI:0.836-0.949).At the maximum value of the Youden index(0.661),the model achieved a sensitivity of 81.0%and a specificity of 85.1%(P<0.001).When the clini-cal data from the validation group were entered into the predictive model,the model demonstrated a sensitivity of 60.0%,a specificity of 94.5%,and an accuracy of 91.1%.Conclusions Age,APACHE-Ⅱ score,intraoperative blood loss,diabetes,and preoperative sleep disturbance are independent risk factors for POD after radical surgery in elderly patients with pan-creatic cancer.The predictive model based on these factors performs well and can help identify patients at low risk of POD,optimize resource allocation,and guide early intervention.关键词
胰腺癌/术后谵妄/危险因素/预测模型Key words
Pancreatic cancer/Postoperative delirium/Risk factors/Predictive model分类
医药卫生
