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护理学报 ›› 2022, Vol. 29 ›› Issue (2): 1-6.doi: 10.16460/j.issn1008-9969.2022.02.001

• 研究生园地 •    下一篇

基于Logistic回归与决策树模型的结直肠癌术后患者非计划性再入院影响因素分析

陈静文1, 徐林霞2, 吴秀丽1, 李显蓉2   

  1. 1.西南医科大学 护理学院,四川 泸州 646000;
    2.西南医科大学附属医院 胃肠外科,四川 泸州 646000
  • 收稿日期:2021-08-02 出版日期:2022-01-25 发布日期:2022-02-15
  • 通讯作者: 李显蓉（1968-）,女,四川泸州人,本科学历,主任护师,科护士长。E-mail:1204987356@qq.com
  • 作者简介:陈静文（1995-）,女,四川眉山人,本科学历,硕士研究生在读,护士。
  • 基金资助:
    四川省科技厅科技计划项目（2020JDKP0095）

Risk Factors of Unplanned Readmission in Postoperative Patients with Colorectal Cancer: An Analysis Based on Logistic Regression and Decision Tree

CHEN Jing-wen1, XU Lin-xia2, WU Xiu-li1, LI Xian-rong2   

  1. 1. School of Nursing, Southwest Medical University, Luzhou 646000, China;
    2. Dept. of Gastrointestinal Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
  • Received:2021-08-02 Online:2022-01-25 Published:2022-02-15

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摘要： 目的 采用Logistic回归模型与决策树模型分析结直肠癌术后患者非计划性再入院的影响因素。方法 回顾性分析2018年3月—2019年12月在胃肠外科接受手术治疗的1 383例结直肠癌患者的临床病例资料,分别建立Logistic回归模型与决策树模型,比较2种模型的分析结果。结果 1 383例结直肠癌术后患者71例非计划性再入院,非计划性再入院率为5.13%。Logistic回归模型分析显示,术后并发症、肿瘤TNM分期≥III期、术前合并症≥2项是结直肠癌术后患者非计划性再入院的独立危险因素。决策树模型分析显示,术后并发症是最主要的危险因素,其后依次为术前合并症≥2项、肿瘤TNM分期≥III期、肠造口、手术方式。Logistic回归模型的ROC曲线下面积为0.773,决策树模型为0.790,2个模型的ROC曲线下面积差异无统计学意义（Z=0.414,P>0.05）。结论 术后并发症、肿瘤TNM分期≥III期和术前合并症≥2项是结直肠癌术后患者非计划性再入院的重要影响因素,Logistic回归模型与决策树模型对结直肠癌术后患者非计划性再入院影响因素的分析结果有较高的一致性,临床护士需采取针对性的预防和护理干预措施,降低患者非计划性再入院率。

关键词: Logistic回归, 决策树, 结直肠癌, 非计划性再入院

Abstract: Objective To analyze the risk factors of unplanned readmission in postoperative patients with colorectal cancer by logistic regression model and decision tree. Methods Clinical data of 1,383 patients with colorectal cancer who underwent surgery in department of gastrointestinal surgery from March 2018 to December 2019 were analyzed retrospectively. Logistic regression model and decision tree model were established respectively, and the results of the two models were compared. Results Seventy-one patients were readmitted unplannedly, with an unplanned readmission rate of 5.13%. Logistic regression model showed that postoperative complications, TNM stage≥III and more than 2 preoperative complications were independent risk factors. Decision tree model showed that postoperative complication was the main risk factor, followed by more than 2 preoperative complications, TNM stage≥III, enterostomy and operation methods. The area under the ROC curve of the logistic regression model was 0.773 and that of the decision tree model 0.790. There was no significant difference in the area under the ROC curve between the two models（Z=0.414,P>0.05）. Conclusion Postoperative complications,TNM stage≥III and more than 2 preoperative complications are important influencing factors of unplanned readmission in postoperative patients with colorectal cancer. Logistic regression model and decision tree model have high consistency in the analysis of risk factors. Clinical nurses should take targeted prevention and nursing interventions to reduce the rate of unplanned readmission.

Key words: logistic regression, decision tree, colorectal cancer, unplanned readmission

中图分类号: 

  • R473.6
[1] Damle RN, Alavi K.Risk Factors for 30d Readmission after Colorectal Surgery: A Systematic Review[J]. J Surg Res, 2016, 200(1):200-207. DOI:10.1016/j.jss.2015.06.052.
[2] Deschepper M, Eeckloo K, Vogelaers D, et al.A Hospital Wide Predictive Model for Unplanned Readmission Using Hierarchical ICD Data[J].Comput Methods Programs Biomed, 2019,173(1):177-183. DOI:10.1016/j.cmpb.2019.02.007.
[3] 肖苏琴,刘芬,黄雅莲,等. 基于Logistic回归与决策树模型的初产妇分娩恐惧的影响因素分析[J]. 护理学报,2020,27(18):1-5. DOI:10.16460/j.issn1008-9969.2020.18.001.
[4] 李爽境,黄闪闪,刘熹润,等.决策树模型与logistic回归模型在代谢综合征影响因素分析中的应用—以凉山地区为例[J].现代预防医学,2019,46(13):2319-2323.
[5] Pucciarelli S, Zorzi M, Gennaro N, et al.In-hospital Mortality, 30-day Readmission, and Length of Hospital Stay after Surgery for Primary Colorectal Cancer: A National Population-based Study[J]. Eur J Surg Oncol, 2017,43(7):1312-1323. DOI:10.1016/j.ejso.2017.03.003.
[6] Bennedsen ALB, Eriksen JR, Gögenur I.Prolonged Hospital Stay and Readmission Rate in an Enhanced Recovery after Surgery Cohort Undergoing Colorectal Cancer Surgery[J]. Colorectal Dis, 2018,20(12):1097-1108. DOI:10.1111/codi.14446.
[7] Almussallam B, Joyce M, Marcello PW, et al.What Factors Predict Hospital Readmission after Colorectal Surgery?[J]. Am Surg, 2016,82(5):433-438.
[8] Curtis NJ, Noble E, Salib E, et al.Does Hospital Readmission Following Colorectal Cancer Resection and Enhanced Recovery after Surgery Affect Long Term Survival?[J].Colorectal Dis, 2017,19(8):723-730. DOI:10.1111/codi.13603.[9] Kelley KA, Young JI, Bassale S, et al. Travel Distance Influences Readmissions in Colorectal Cancer Patients What the Primary Operative Team Needs to Know[J].J Surg Res, 2018 ,227(1):220-227. DOI10.1016/j.jss.2018.02.022.
[10] 何小东,黄明浩,张倩,等.结直肠癌患者术后非计划性再入院影响因素分析[J].解放军预防医学杂志, 2019,37(10):92-94. DOI:10.13704/j.cnki.jyyx.2019.10.044.
[11] Yang J, Xiao J, Feng J, et al.One-year Unplanned Readmission after Colorectal Cancer Surgery in Western China[J]. J Invest Surg, 2019,32(7):602-606.DOI:10.1080/08941939.2018.1443176.
[12] Quintana JM, Anton-Ladislao A, Lázaro S, et al.Predictors of Readmission and Reoperation in Patients with Colorectal Cancer[J]. Support Care Cancer, 2020,28(5):2339-2350. DOI:10.1007/s00520-019-05050-2.
[13] 刘从兴,石欣. 胃癌术后出院30天内非计划再入院影响因素的探讨[J]. 东南大学学报(医学版),2018,37(1):178-182. DOI:10.3969/j.issn.1671-6264.2018.01.040.
[14] 杨青,王国蓉,江宾,等. 基于决策树的肿瘤患者难免性压疮风险预测模型研究[J]. 护理学杂志,2019,34(13):4-7. DOI:10.3870/j.issn.1001-4152.2019.13.004.
[15] 高多多,张爱莲,任雯娟. 基于CHAID模型的某县农村居民生活方式影响因素分析[J]. 中国卫生统计,2020,37(5):659-663. DOI:10.3969/j.issn.1002-3674.2020.05.005.
[16] Wick EC, Shore AD, Hirose K, et al.Readmission Rates and Cost Following Colorectal Surgery[J]. Dis Colon Rectum, 2011,54(12):1475-1479.DOI:10.1097/DCR.0b013e31822ff8f0.
[17] Ang CW, Seretis C, Wanigasooriya K, et al.The Most Frequent Cause of 90-day Unplanned Hospital Readmission Following Colorectal Cancer Resection Is Chemotherapy Complications[J]. Colorectal Dis,2015,17(9):779-786. DOI: 10.1111/codi.12945.
[18] 袁成菊,余昌胤,张年,等. 我国分级诊疗研究热点的文献计量学分析[J]. 中国全科医学,2020,23(19):2390-2395. DOI:10.12114/j.issn.1007-9572.2020.00.202.
[19] Francis NK, Mason J, Salib E, et al.Factors Predicting 30-day Readmission after Laparoscopic Colorectal Cancer Surgery within an Enhanced Recovery Programme[J]. Colorectal Dis, 2015,17(7):148-154. DOI:10.1111/codi.13002.
[20] Greenblatt DY, Weber SM, O’Connor ES, et al. Readmission after Colectomy for Cancer Predicts One-year Mortality[J]. Ann Surg, 2010,251(4):659-669.DOI:10.1097/SLA.0b013e3181d3d27c.
[21] 黄贵和,陆咏江,易应松,等. 结直肠癌术后急性肠梗阻的危险因素分析[J]. 现代肿瘤医学,2019,27(14):2531-2534. DOI:10.3969/j.issn.1672-4992.2019.14.025.
[22] Chen SY, Stem M, Gearhart SL, et al.Readmission Adversely Affects Survival in Surgical Rectal Cancer Patients[J]. World J Surg, 2019,43(10):2506-2517.DOI:10.1007/s00268-019-05053-4.
[23] Lawson EH, Hall BL, Louie R, et al.Association between Occurrence of a Postoperative Complication and Readmission: Implications for Quality Improvement and Cost Savings[J]. Ann Surg, 2013,258(1):10-18. DOI:10.1097/SLA.0b013e31828e3ac3.
[24] Orcutt ST, Li LT, Balentine CJ, et al.Ninety-day Readmission after Colorectal Cancer Surgery in a Veterans Affairs Cohort[J]. J Surg Res, 2016, 201(2):370-377.DOI:10.1016/j.jss.2015.11.026.
[25] Chung JS, Kwak HD, Ju JK.Thirty-day Readmission after Elective Colorectal Surgery for Colon Cancer: A Single-center Cohort Study[J]. Ann Coloproctol, 2020,36(3):186-191. DOI:10.3393/ac.2019.11.04.
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