Predicting postoperative fever after endoscopic submucosal dissection (ESD) for colorectal lesions is now more precise, thanks to a newly developed nomogram. This tool draws from data collected over 13 years to identify the likelihood of fever occurring following the procedure, which can often complicate recovery.
The research, conducted at the First Affiliated Hospital of Nanchang University, involved 1,096 patients who underwent ESD between June 2008 and December 2021. Fever was identified as a common postoperative complication, affecting 204 of those patients, or 18.6%. The goal was to explore the incidence and risk factors associated with fever following colorectal ESD, leading to the development of the predictive nomogram.
Postoperative fever after ESD, considered mild but worrisome, can be indicative of more serious complications like delayed perforation. Through multivariate analyses, researchers pinpointed four independent risk factors contributing to the likelihood of fever: tumor size, ESD procedure time exceeding 30 minutes, injury to the muscle layer, and intraoperative perforation.
The study found significant correlations between these variables and the incidence of fever. For example, larger tumor size and prolonged procedure duration were both independently associated with increased risks. Specifically, for each additional millimeter of tumor size, the likelihood of developing fever increased.
Out of the 204 patients who experienced fever post-ESD, many demonstrated elevated white blood cell counts and increased C-reactive protein levels, signaling inflammation though the incidence of bacteremia was low. The nomogram created from this data aims to quantify risk based on the identified variables, providing medical professionals with the ability to foresee the likelihood of fever and potentially mitigate postoperative discomfort.
During the study, patients were randomly divided between those included for training the model and those for validation. The resulting nomogram displayed good predictive accuracy, with the area under the receiver operating characteristic curve (AUC) reaching 0.752 for the training group and 0.727 for the validation group. This suggests the tool's reliable performance across different patient subsets.
Notably, the researchers emphasized the clinical applicability of the nomogram. By incorporating variables easily obtained during preoperative assessments, clinicians can more accurately anticipate which patients are at higher risk for developing fever. This predictive ability could lead to enhanced postoperative monitoring and potentially even preventative measures, aiming to improve overall patient outcomes.
Dr. Qiu, one of the researchers, explained how this model not only aids medical teams but also helps patients understand their risk factors, potentially easing anxiety related to postoperative recovery. 'Identifying patients who are more prone to complications allows for proactive management,' Dr. Qiu noted.
Future steps include validating the nomogram’s effectiveness across multiple centers and examining its impact on clinical decision-making. By providing such predictive insights, the aim is to refine approaches to postoperative care following ESD and, ideally, streamline recovery experiences for colorectal surgery patients.
The development and validation of this nomogram represent significant advancements in personalized patient care following ESD and highlight the importance of risk assessment strategies to improve clinical outcomes.