Development and validation of a nomogram to predict perioperative blood transfusion for gastric cancer surgery

Abstract Background This study aimed to construct and validate a nomogram composed of preoperative variables to predict perioperative blood transfusion for gastric cancer surgery. Methods 600 gastric cancer patients undergoing gastrectomy between January 2010 and December 2015 were selected as primary cohort. 399 patients from January 2016 to June 2019 were collected as validation cohort. In the primary cohort, univariate and multivariate analyses were performed to identify independent risk factors for blood transfusion. Using Akaike information criterion, selected variables were incorporated to construct a nomogram. Validations of the nomogram were performed in the primary and validation cohort. Discrimination of the nomogram was assessed by the concordance index (C-index) and calibration of the nomogram was assessed by calibration curve and Hosmer–Lemeshow goodness-of-fit test. Results The following independent risk factors for transfusion were identified: Charlson comorbidity index score over 3 (odds ratio (OR) 2.15), tumor location (diffuse vs upper: OR 1.50), pTNM stage (III vs I: OR 3.17), type of gastrectomy (subtotal vs total gastrectomy: OR 0.58), extragastric organ resection (OR 2.03) and preoperative hemoglobin less than 80 g/l (vs over 120 g/l: OR 66.03). C-index was 0.863 and 0.901 in the primary and validation cohort, respectively, indicating good discrimination of the nomogram. Both calibration curves and Hosmer–Lemeshow goodness-of-fit tests (P-value 0.716 and 0.935) demonstrated high agreement between prediction and actual outcome. Conclusion A nomogram composed of preoperative variables to predict blood transfusion for gastric cancer surgery was developed and validated. This nomogram could be used to improve utilization of packed red blood cells.

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Risk factors for peripheral venous catheter failure: A prospective cohort study of 5345 patients

The Journal of Vascular Access ◽

10.1177/11297298211015035 ◽

2021 ◽

pp. 112972982110150

Author(s):

Ya-mei Chen ◽

Xiao-wen Fan ◽

Ming-hong Liu ◽

Jie Wang ◽

Yi-qun Yang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cohort Study ◽

Goodness Of Fit ◽

Insertion Site ◽

Healthcare Providers ◽

Venous Catheter ◽

Goodness Of Fit Test ◽

Peripheral Venous Catheter ◽

Independent Risk Factors

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.

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A Prospective Multicenter Observational Study of Venous Thromboembolism after Gastric Cancer Surgery (SHISA-1601)

European Surgical Research ◽

10.1159/000514309 ◽

2021 ◽

pp. 1-10

Author(s):

Sachiko Kaida ◽

Toru Miyake ◽

Satoshi Murata ◽

Tsuyoshi Yamaguchi ◽

Takeshi Tatsuta ◽

...

Keyword(s):

Gastric Cancer ◽

Venous Thromboembolism ◽

Blood Transfusion ◽

Observational Study ◽

Characteristic Curve ◽

Cancer Surgery ◽

Gastric Cancer Surgery ◽

Multicenter Observational Study ◽

Prospective Multicenter Observational Study ◽

D Dimer

Introduction: This study aimed to clarify the frequency and risk factors of intercurrent venous thromboembolism (VTE) in patients undergoing major curative gastric cancer surgery. Methods: This prospective, multicenter, observational study included patients with gastric cancer who underwent radical gastrectomy at 5 hospitals between June 2016 and May 2018. Patients who were preoperatively administered anticoagulants were excluded. Results: A total of 126 patients were eligible to participate. VTE occurred within 9 days postoperatively in 5 cases (4.0%; 2 symptomatic and 3 asymptomatic). Postoperative day (POD) 1 plasma D-dimer and soluble fibrin (SF) levels were significantly higher in the VTE group than in the non-VTE group. Receiver-operating characteristic curve (ROC) analysis indicated a statistically significant ability of POD 1 D-dimer and SF levels to predict postoperative VTE development after gastrectomy; this finding was reflected by an area under the curve (AUC) of 0.97 (95% CI 0.92–1.0) and 0.87 (95% CI 0.74–1.0), respectively. Cutoff values of D-dimer (24.6 µg/mL) and SF (64.1 µg/mL) were determined. Intraoperative blood transfusion (odds ratio [OR] 7.86), POD 1 D-dimer ≥24.6 µg/mL (OR 17.35), and POD 1 SF ≥64.1 µg/mL (OR 19.5) were independent predictive factors for postoperative VTE (p < 0.05). Conclusion: VTE occurred in 4.0% patients (1.6% symptomatic and 2.4% asymptomatic) after gastric cancer surgery; however, with an early diagnosis and anticoagulant therapy, no patients experienced progression. Careful observation of patients with a high risk for VTE, including intraoperative blood transfusion and high POD 1 D-dimer or SF levels, would contribute to the early detection of VTE.

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Risk Factors for Gallbladder Stone Formation after Gastric Cancer Surgery

Journal of Gastric Cancer ◽

10.5230/jgc.2019.19.e37 ◽

2019 ◽

Vol 19 (4) ◽

pp. 417

Author(s):

Young-Won Lee ◽

Amy Kim ◽

Minkyu Han ◽

Moon-Won Yoo

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Stone Formation ◽

Cancer Surgery ◽

Gallbladder Stone ◽

Gastric Cancer Surgery

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The incidence and risk factors for surgical site infection in older adults after gastric cancer surgery

Medicine ◽

10.1097/md.0000000000016739 ◽

2019 ◽

Vol 98 (32) ◽

pp. e16739

Author(s):

Jung Ho Kim ◽

Jinnam Kim ◽

Woon Ji Lee ◽

Hye Seong ◽

Heun Choi ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Older Adults ◽

Surgical Site Infection ◽

Cancer Surgery ◽

Site Infection ◽

Gastric Cancer Surgery

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PCN20 ASSOCIATION OF INSURANCE COVERAGE AND EPIDEMIOLOGICAL RISK FACTORS ON GASTRIC CANCER SURGERY

Value in Health ◽

10.1016/s1098-3015(10)61011-x ◽

2002 ◽

Vol 5 (3) ◽

pp. 202

Author(s):

W Wu ◽

B Donato ◽

P Grossman ◽

P Hines

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Insurance Coverage ◽

Cancer Surgery ◽

Gastric Cancer Surgery ◽

Epidemiological Risk

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Impact of preoperative sarcopenia on recurrecnce in gastric cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.120 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 120-120

Author(s):

Tsutomu Sato ◽

Toru Aoyama ◽

Yukio Maezawa ◽

Kazuki Kano ◽

Kenki Segami ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Skeletal Muscle ◽

Risk Factor ◽

Muscle Mass ◽

Significant Risk ◽

Cancer Surgery ◽

Pathological Stage ◽

Gastric Cancer Surgery ◽

Negative Prognostic Factor

120 Background: Our previous study clarified that morbidity was a negative prognostic factor and sarcopenia defined by of the handgrip strength was a risk factor for the morbidity in gastric cancer surgery. Sarcopenia was reportedly a negative prognostic factor in colorectal cancer, hepatocellular carcinoma and malignant melanoma. This study aimed to evaluate impact of preoperative sarcopenia on recurrence-free survival (RFS) in gastric cancer surgery. Methods: Between May 2011 and June 2013, 256 consecutive primary gastric cancer patients who underwent curative surgery were retrospectively examined. Patients who received neoadjuvant chemotherapy or were diagnosed with pathological stage IV were excluded. Preoperative skeletal muscle mass was evaluated by bioelectrical impedance analysis and was expressed as skeletal muscle index or SMI (muscle mass/height2) by adjusting absolute muscle mass with height. Preoperative muscle function was measured by hand grip strength (HGS). Each cutoff value was determined as the gender-specific lowest 20% of the distribution of each measurement. Univariate and multivariate analyses were preformed to identify risk factors for RFS using a Cox proportional hazards model. Results: Median age (range) was 66 years (37-85 years). Male to female ratio was 168:88. Median follow-up period was 33.4 months. Pathological stage was I in 160, II in 48 and III in 48 patients. Univariate analysis showed that age, adjuvant chemotherapy, pT, pN, histological type, tumor size, total gastrectomy, low SMI and low HGS were significant risk factors for RFS. Multi-variate Cox’s proportional hazard analyses demonstrated that pT (HR 2.76, p = 0.0001), pN (HR 1.375, p = 0.037), histological type (HR 3.46, p = 0.014), low SMI (HR2.17, p = 0.036) were the significant risk factors for RFS. The three-year RFS was 89.1% in the patients with high SMI and 73.2% in those with low SMI (p = 0.007). Conclusions: Low SMI was an independent risk factor for RFS in Stage I-III gastric cancer. Low HGS, a risk factor for morbidity shown in our previous study, was not a risk independent factor for RFS. Preoperative sarcopenia as the short- and long-term outcomes has a value to be tested in the future prospective studies in gastric cancer surgery.

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