Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 104459
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.104459
Construction of a risk prediction model for postoperative cognitive dysfunction in colorectal cancer patients
Zhen-Ping Zheng, Yong-Guo Zhang, Ming-Bo Long, Kui-Quan Ji, Jin-Yan Peng, Kai He
Zhen-Ping Zheng, Yong-Guo Zhang, Ming-Bo Long, Kui-Quan Ji, Jin-Yan Peng, Kai He, Department of Anesthesiology, The People’s Hospital of Qian Nan, Duyun 558000, Guizhou Province, China
Author contributions: Zheng ZP and He K contributed to the conception and design of the study, data acquisition and analysis, and analyzed the data and wrote the manuscript; Zhang YG assisted with study design; Long MB assisted with data collection; Ji KQ performed data analysis; Peng JY and He K supervised and coordinated the project.
Supported by the Research Fund of Qiannan Medical College for Nationalities, No. Qnyz202222.
Institutional review board statement: This study was approved by the Ethics Committee of The People’s Hospital of Qian Nan (No. 2024-qnzy-25).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable 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: Kai He, Chief Physician, Department of Anesthesiology, The People’s Hospital of Qian Nan, No. 9 Wenfeng Road, Duyun 558000, Guizhou Province, China. hekai1593698@163.com
Received: December 27, 2024
Revised: February 6, 2025
Accepted: February 24, 2025
Published online: April 27, 2025
Processing time: 91 Days and 23.3 Hours
Abstract
BACKGROUND

Colorectal cancer (CRC) is one of the most prevalent and lethal malignant tumors worldwide. Currently, surgical intervention was the primary treatment modality for CRC. However, increasing studies have revealed that CRC patients may experience postoperative cognitive dysfunction (POCD).

AIM

To establish a risk prediction model for POCD in CRC patients and investigate the preventive value of dexmedetomidine (DEX).

METHODS

A retrospective analysis was conducted on clinical data from 140 CRC patients who underwent surgery at the People’s Hospital of Qian Nan from February 2020 to May 2024. Patients were allocated into a modeling group (n = 98) and a validation group (n = 42) in a 7:3 ratio. General clinical data were collected. Additionally, in the modeling group, patients who received DEX preoperatively were incorporated into the observation group (n = 54), while those who did not were placed in the control group (n = 44). The incidence of POCD was recorded for both cohorts. Data analysis was performed using statistical product and service solutions 20.0, with t-tests or χ2 tests employed for group comparisons based on the data type. Least absolute shrinkage and selection operator regression was applied to identify influencing factors and reduce the impact of multicollinear predictors among variables. Multivariate analysis was carried out using Logistic regression. Based on the identified risk factors, a risk prediction model for POCD in CRC patients was developed, and the predictive value of these risk factors was evaluated.

RESULTS

Significant differences were observed between the cognitive dysfunction group and the non-cognitive dysfunction group in diabetes status, alcohol consumption, years of education, anesthesia duration, intraoperative blood loss, intraoperative hypoxemia, use of DEX during surgery, intraoperative use of vasoactive drugs, surgical time, systemic inflammatory response syndrome (SIRS) score (P < 0.05). Multivariate Logistic regression analysis identified that diabetes [odds ratio (OR) = 4.679, 95% confidence interval (CI) = 1.382-15.833], alcohol consumption (OR = 5.058, 95%CI: 1.255-20.380), intraoperative hypoxemia (OR = 4.697, 95%CI: 1.380-15.991), no use of DEX during surgery (OR = 3.931, 95%CI: 1.383-11.175), surgery duration ≥ 90 minutes (OR = 4.894, 95%CI: 1.377-17.394), and a SIRS score ≥ 3 (OR = 4.133, 95%CI: 1.323-12.907) were independent risk factors for POCD in CRC patients (P < 0.05). A risk prediction model for POCD was constructed using diabetes, alcohol consumption, intraoperative hypoxemia, non-use of DEX during surgery, surgery duration, and SIRS score as factors. A receiver operator characteristic curve analysis of these factors revealed the model’s predictive sensitivity (88.56%), specificity (70.64%), and area under the curve (AUC) (AUC = 0.852, 95%CI: 0.773-0.919). The model was validated using 42 CRC patients who met the inclusion criteria, demonstrating sensitivity (80.77%), specificity (81.25%), and accuracy (80.95%), and AUC (0.805) in diagnosing cognitive impairment, with a 95%CI: 0.635-0.896.

CONCLUSION

Logistic regression analysis identified that diabetes, alcohol consumption, intraoperative hypoxemia, non-use of DEX during surgery, surgery duration, and SIRS score vigorously influenced the occurrence of POCD. The risk prediction model based on these factors demonstrated good predictive performance for POCD in CRC individuals. This study offers valuable insights for clinical practice and contributes to the prevention and management of POCD under CRC circumstances.

Keywords: Colorectal cancer; Postoperative; Cognitive dysfunction; Anesthesia; Risk prediction model; Dexmedetomidine; Preventive value

Core Tip: This study developed a risk prediction model for postoperative cognitive dysfunction (POCD) in colorectal cancer (CRC) patients, identifying key risk factors such as diabetes, alcohol consumption, intraoperative hypoxemia, non-use of dexmedetomidine (DEX), surgery duration ≥ 90 minutes, and a systemic inflammatory response syndrome score ≥ 3. The model demonstrated good predictive performance, with high sensitivity and specificity, and highlights the preventive value of DEX in reducing POCD incidence. This research provides valuable insights for improving POCD prevention and management in CRC patients.