1. Introduction
bleeding, anastomotic fistula, disease behavior, intestinal fistula, Crohn disease, postoperative intestinal fistula, infection, fistula, abdominal abscess
BLEEDING, GASTROINTESTINAL DISEASES, POSTOPERATIVE COMPLICATIONS, DISEASE, CROHN DISEASE, SHORT BOWEL SYNDROME, INFECTION, REGRESSION, ABDOMINAL ABSCESS, INTESTINAL PERFORATION, INFLAMMATORY DISEASE, COMPLICATIONS
The aim of this study was to (1) assess the independent factors affecting patients with postoperative intestinal fistula from Crohn disease (CD) by analyzing preoperative clinical data, (2) establish a nomogram prediction model for this condition based on these factors, and (3) validate this model and evaluate its accuracy. In this retrospective multicenter case-control study, the clinical data of 240 patients with CD admitted for surgical treatment between September 2019 and September 2021 at 3 centers were collected. Patients were randomly divided into a training set (168 patients) and a validation set (72 patients). Univariate analysis was performed for relevant factors, and statistically significant factors were then analyzed using multivariate logistic regression to determine the independent influencing factors. A nomogram model for predicting postoperative intestinal fistula in patients with CD was constructed and the accuracy of the model was evaluated using calibration curves. Univariate analysis showed that disease behavior, abdominal abscess, intestinal perforation, neutrophil-to-lymphocyte ratio, systemic immunoinflammatory index, and prognostic nutrition index were factors affecting postoperative intestinal fistula in patients with CD. Multivariate logistic regression analysis showed that neutrophil-to-lymphocyte ratio, prognostic nutrition index, disease behavior, and Crohn disease activity index score were independent influencing factors. After assessing the validation set, the area under the curve was 0.899, indicating good predictive accuracy of the nomogram model. The prediction model developed in this study can effectively predict the risk of postoperative intestinal fistula.Crohn disease (CD) is a chronic nonspecific inflammatory disease of the bowel. Despite being a major treatment modality, surgery for CD is associated with more numerous and severe postoperative complications (anastomotic fistula, intestinal fistula, multisite infection, bleeding, and short bowel syndrome) than that for other gastrointestinal diseases. These complications affect the quality of life of patients, prolong the duration of hospitalization, and lead to reoperation.