Analysis of influencing factors for anesthesia recovery time after gastric cancer surgery in patients with type 2 diabetes mellitus and establishment of a nomogram model / 中国医师进修杂志

ABSTRACT

Objective:To analyze the influencing factors of anesthesia recovery time after gastric cancer surgery in patients with type 2 diabetes mellitus (T2DM), and establish a nomogram model.Methods:The clinical data of 120 T2DM patients underwent open surgery for gastric cancer from February 2020 to January 2021 in Handan Central Hospital were retrospectively analyzed. Among them, 50 patients had an anesthesia recovery time>30 min (observation group), and 70 patients had an anesthesia recovery time≤30 min (control group). Multivariate Logistic regression was used to analyze the independent risk factors of anesthesia recovery time after gastric cancer surgery in patients with T2DM. Receiver operating characteristic (ROC) curve was drawn to analyze the optimal cut-off value of each influencing factor for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM. A nomogram model to predict anesthesia recovery time after gastric cancer surgery in patients with T2DM was established with R language software 4.0 "rms" package.Results:The proportion of men, age, decrease amplitude of postoperative temperature, operation time intraoperative blood transfusion rate in observation group were significantly higher than those in control group 84.00% (42/50) vs. 20.00% (14/70), (60.31 ± 14.23) years vs. (47.58 ± 8.96) years, (0.33 ± 0.09) ℃ vs. (0.28 ± 0.08) ℃, (92.32 ± 8.58) min vs. (84.54 ± 6.24) min and 38.00% (19/50) vs. 10.00% (7/70), the body mass index (BMI), heart rate and operating room temperature were significantly lower than those in control group (20.11 ± 3.96) kg/m 2 vs. (24.69 ± 4.58) kg/m 2, (103.73 ± 9.57) beats/min vs. (118.32 ± 18.15) beats/min and (28.66 ± 1.58) ℃ vs. (30.25 ± 1.98) ℃, and there were statistical differences ( P<0.01); there were no statistical differences in smoking, drinking, hypertension, hyperlipidemia, coronary heart disease, anesthetic drug types, anesthesiologist job title, muscle relaxant drug types and body temperature between 2 groups ( P>0.05). ROC curve analysis results showed that the optimal cut-off values of age, BMI, heart rate, decrease amplitude of postoperative temperature, operating room temperature and operation time for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM were 46 years old, 21.8 kg/m 2, 113 beats/min, 0.3 ℃, 30.6 ℃ and 91 min, respectively. Multivariate Logistic regression analysis results showed that gender (male), age (>46 years old), BMI (≤21.8 kg/m 2), decrease amplitude of postoperative temperature (>0.3 ℃), operating room temperature (≤30.6 ℃) and operation time (>91 min) were independent risk factors for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM ( OR = 1.909, 1.815, 1.606, 1.458, 1.521 and 1.539; 95% CI 1.215 to 3.000, 1.014 to 3.249, 1.252 to 1.941, 1.251 to 1.628, 1.068 to 2.167 and 1.119 to 1.828; P<0.01 or<0.05). When gender, age, BMI, decrease amplitude of postoperative temperature, operating room temperature and operation time were included as predictors for constructing the nomogram model, the internal validation results showed that the c-index of the nomogram model for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM was 0.701 (95% CI 0.672 to 0.724); calibration curve showed good agreement between observed value and predicted value; the threshold value of the nomogram model for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM was>0.20, and the nomogram model provided a net clinical benefit; the clinical net benefit of the nomogram model was greater than that of sex, age, BMI, decrease amplitude of postoperative temperature, operating room temperature and operation time. Conclusions:A nomogram model to predict anesthesia recovery time after gastric cancer surgery in patients with T2DM is constructed based on gender, age, BMI, decrease amplitude of postoperative temperature, operating room temperature and operation time, and this model is significant for predicting anesthesia recovery time after gastric cancer surgery in patients with T2DM.