A nomogram to predict prolonged postoperative ileus after intestinal resection for Crohn's disease

Purpose We aim to identify the risk factors of PPOI in patients with CD and create a nomogram for prediction of PPOI for CD. Methods Data on 462 patients who underwent partial intestinal resection for CD in Jin-ling Hospital between January 2019 and June 2021 were retrospectively collected. Univariate and multivariate analyses were performed to determine the risk factors for PPOI and we used the risk factors to create a nomogram. Then we used the Bootstrap-Concordance index and calibration diagrams to evaluate the performance of the Nomogram. Decision curve analysis was performed to evaluate clinical practicability of the model. Results The incidence of PPOI was 27.7% (n of N). Course of CD >= 10 years, operation time >= 154 min, the lowest mean arterial pressure <= 76.2 mmHg, in-out balance per body weight >= 22.90 ml/kg, post-op day 1 infusion >= 2847 ml, post-op lowest K+ <= 3.75 mmol/L, and post-op day 1 procalcitonin >= 2.445 ng/ml were identified as the independent risk factors of PPOI in patients with CD. The nomogram we created by these risk factors presented with good discriminative ability (concordance index 0.723) and was moderately calibrated (bootstrapped concordance index 0.704). The results of decision curve analysis showed that the nomogram was clinically effective within probability thresholds in the 8 to 66% range. Conclusion The nomogram we developed is helpful to evaluate the risk of developing PPOI after partial intestinal resection for CD. Clinicians can take more necessary measures to prevent PPOI in CD's patients or at least minimize the incidence.

Automated summary

This study aimed to identify the risk factors and develop a nomogram for predicting postoperative ileus (PPOI) in patients with Crohn's disease (CD) who underwent partial intestinal resection. The results showed that disease duration, operation time, lowest mean arterial pressure, fluid balance, postoperative infusion, lowest potassium concentration, and procalcitonin level were independent risk factors for PPOI in CD patients. The nomogram based on these risk factors had good discriminative ability and clinical effectiveness.