Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2176-2188
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2176
Predicting surgical site infections using a novel nomogram in patients with hepatocelluar carcinoma undergoing hepatectomy
Tian-Yu Tang, Yi Zong, Yi-Nan Shen, Cheng-Xiang Guo, Xiao-Zhen Zhang, Xiu-Wen Zou, Wei-Yun Yao, Ting-Bo Liang, Xue-Li Bai
Tian-Yu Tang, Yi-Nan Shen, Cheng-Xiang Guo, Xiao-Zhen Zhang, Xiu-Wen Zou, Ting-Bo Liang, Xue-Li Bai, Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Yi Zong, The 5th Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 20000, China
Wei-Yun Yao, Department of Surgery, Changxing People’s Hospital, Huzhou 313000, Zhejiang Province, China
Author contributions: All authors helped to perform the research; Tang TY, Zong Y, and Shen YN wrote the manuscript; Tang TY, Zong Y, Shen YN, Guo CX, Zhang XZ, Zou XW, and Yao WY performed the procedures and analyzed the data; Liang TB and Bai XL contributed to study conception and design.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: 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/
Corresponding author: Ting-Bo Liang, MD, PhD, Attending Doctor, Chief Doctor, Full Professor, Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310009, Zhejiang Province, China. liangtingbo@zju.edu.cn
Telephone: +86-571-87236688 Fax: +86-571-87236688
Received: April 24, 2019
Peer-review started: April 24, 2019
First decision: June 4, 2019
Revised: June 22, 2019
Accepted: July 3, 2019
Article in press: July 3, 2019
Published online: August 26, 2019
Processing time: 124 Days and 11.5 Hours
Abstract
BACKGROUND

Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for hepatocellular carcinoma (HCC).

AIM

To identify the risk factors associated with SSI, and develop a nomogram to predict SSI among patients undergoing hepatectomy.

METHODS

We retrospectively reviewed the data of patients diagnosed with HCC undergoing hepatectomy at two academic institutions in China, and evaluated the occurrence of SSI. Independent risk factors for SSI were identified using univariate and multivariate analyses. Based on these independent risk factors, a nomogram was established using the data of patients in the first institution, and was validated using data from an external independent cohort from the second institution.

RESULTS

The nomogram was established using data from 309 patients, whereas the validation cohort used data from 331 patients. The operation duration, serum albumin level, repeat hepatectomy, and ASA score were identified as independent risk factors. The concordance index (C-index) of the nomogram for SSI prediction in the training cohort was 0.86; this nomogram also performed well in the external validation cohort, with a C-index of 0.84. Accordingly, we stratified patients into three groups, with a distinct risk range based on the nomogram prediction, to guide clinical practice.

CONCLUSION

Our novel nomogram offers good preoperative prediction for SSIs in patients undergoing hepatectomy.

Keywords: Surgical site infection; Nomogram; Hepatectomy; Risk factors

Core tip: Surgical site infections (SSI) remain a major cause of morbidity among patients undergoing liver resection. The aim of this study was to establish a nomogram to predict SSI in patients who underwent hepatectomy for hepatocellular carcinoma. A total of 309 patients were used to develop the prediction model based on identified risk factors, and 331 patients were used as an external validation cohort. The prediction model showed better performance comparing to National Nosocomial Infection surveillance risk index both in training and validation cohorts. This nomogram integrating information of medical history, liver function, performance status, and intra-operative risk may have a potential for helping surgeons identify the patients with increased risk of SSI in clinical practice.