Song SS, Lin L, Li L, Han XD. Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer. World J Gastrointest Surg 2024; 16(7): 2194-2201 [PMID: 39087110 DOI: 10.4240/wjgs.v16.i7.2194]
Corresponding Author of This Article
Xiao-Dong Han, MM, Chief Physician, Department of Anesthesia and Surgery, Wenzhou Central Hospital, No. 252 Baili East Road, Lucheng District, Wenzhou 325099, Zhejiang Province, China. hxd1980115@sina.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2194-2201 Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2194
Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer
Shu-Shu Song, Li Lin, Li Li, Xiao-Dong Han
Shu-Shu Song, Li Lin, Li Li, Xiao-Dong Han, Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
Author contributions: Song SS and Han XD designed this research and analyzed the data; Lin L and Li L collected clinical data; Song SS, Lin L, and Li L wrote the manuscript; Han XD reviewed the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Wenzhou Central Hospital (Approval No. L2024-02-030).
Informed consent statement: The ethics committee granted an exemption from obtaining informed consent because this is a retrospective study that does not involve patient privacy.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Anonymous datasets can be obtained from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Dong Han, MM, Chief Physician, Department of Anesthesia and Surgery, Wenzhou Central Hospital, No. 252 Baili East Road, Lucheng District, Wenzhou 325099, Zhejiang Province, China. hxd1980115@sina.com
Received: April 10, 2024 Revised: May 16, 2024 Accepted: June 13, 2024 Published online: July 27, 2024 Processing time: 102 Days and 23.7 Hours
Abstract
BACKGROUND
General anesthesia is commonly used in the surgical management of gastrointestinal tumors; however, it can lead to emergence agitation (EA). EA is a common complication associated with general anesthesia, often characterized by behaviors, such as crying, struggling, and involuntary limb movements in patients. If treatment is delayed, there is a risk of incision cracking and bleeding, which can significantly affect surgical outcomes. Therefore, having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia, which is beneficial for improving patient prognosis.
AIM
To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.
METHODS
Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital (January 2020 to December 2023) was conducted. Post-surgery, the Richmond Agitation-Sedation Scale was used to evaluate EA presence, noting EA incidence after general anesthesia. Patients were categorized by EA presence postoperatively, and the influencing factors were analyzed using logistic regression. A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.
RESULTS
EA occurred in 51 (25.5%) patients. Multivariate analysis identified advanced age, American Society of Anesthesiologists (ASA) grade III, indwelling catheter use, and postoperative pain as risk factors for EA (P < 0.05). Conversely, postoperative analgesia was a protective factor against EA (P < 0.05). The area under the curve of the nomogram was 0.972 [95% confidence interval (CI): 0.947-0.997] for the training set and 0.979 (95%CI: 0.951-1.000) for the test set. Hosmer-Lemeshow test showed a good fit (χ2 = 5.483, P = 0.705), and calibration curves showed agreement between predicted and actual EA incidence.
CONCLUSION
Age, ASA grade, catheter use, postoperative pain, and analgesia significantly influence EA occurrence. A nomogram constructed using these factors demonstrates strong predictive accuracy.
Core Tip: In this study, we retrospectively analyzed clinical data from 200 patients with primary liver cancer undergoing general anesthesia. The aim was to identify key factors influencing postoperative emergence agitation (EA) occurrence and to construct a risk prediction model. The findings revealed advanced age, American Society of Anesthesiologists grade III, indwelling catheter, and postoperative pain as risk factors for EA, whereas postoperative analgesia emerged as a protective factor. Successful construction of a nomogram risk prediction model demonstrated good predictive efficacy, offering a practical tool for the clinical evaluation and prevention of EA.
