[Analysis of influencing factors of incisional infection and construction of risk prediction model in laparoscopic colorectal cancer surgery].
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Objective: To analyze the risk factors for incisional surgical site infection (I-SSI) after laparoscopic colorectal cancer surgery and to construct a risk prediction model, thereby providing a basis for precise clinical prevention. Methods: A retrospective observational study was conducted involving 919 patients who underwent laparoscopic radical colorectal cancer resection at Subei People's Hospital of Yangzhou University of Jiangsu Province from February 2018 to February 2022. The inclusion criteria were as follows: (1) Age ≥ 18 years; (2) Postoperative pathological confirmation of colon or rectal cancer; (3) Surgical approach involving laparoscopic radical resection (including laparoscopic-assisted or totally laparoscopic surgery); and (4) Complete clinicopathological data (including baseline data, surgical records, and postoperative follow-up records). The exclusion criteria included: conversion to open surgery or failure to complete the predetermined surgical plan; concurrent severe infectious diseases (e.g., sepsis or abscess) or immunodeficiency diseases (e.g., AIDS or long-term use of immunosuppressants); severe liver or kidney dysfunction (Child-Pugh grade C); preoperative neoadjuvant chemoradiotherapy; distant metastasis (Stage IV); or concurrent other malignancies. Data including age, gender, body mass index (BMI), medical history, tumor size, prophylactic antibiotic use, surgical type, surgical site, auxiliary incision direction, and incision length were extracted from the electronic medical record system. The primary outcome measure was I-SSI, diagnosed according to the 2017 Centers for Disease Control and Prevention (CDC) guidelines for the prevention of surgical site infection (criteria included purulent drainage, pathogen detection, signs of infection such as pain/redness/swelling/heat, or incision opening by a surgeon within 30 days post-surgery). Univariate and multivariate Logistic regression analyses were used to screen for infection-related risk factors. A nomogram prediction model was constructed using R software, and its performance was evaluated using the Receiver Operating Characteristic (ROC) curve and calibration plot. Results: Among the 919 patients, 55 (6.0%) developed I-SSI (infection group), while the remaining 864 (94.0%) constituted the non-infection group. Compared with the non-infection group, the infection group had significantly higher prevalences of diabetes and hypoproteinemia, higher BMI, and higher proportions of emergency surgery and longitudinal incisions (all P<0.05); the rate of preoperative prophylactic antibiotic use was lower (P=0.022), and the minimum tumor diameter measured by preoperative CT was larger (P<0.001). The difference between incision length and minimum tumor diameter differed significantly between the two groups (P=0.011). Multivariate analysis indicated that diabetes (OR=2.05, 95%CI: 1.10-3.79, P=0.023), hypoproteinemia (OR=3.52, 95%CI: 1.73-7.17, P<0.001), BMI (per 1-unit increase: OR=1.10, 95%CI: 1.02-1.19, P=0.011), and longitudinal incision (OR=2.32, 95%CI: 1.09-4.92, P=0.029) were independent risk factors for postoperative I-SSI. Conversely, elective surgery (OR=0.35, 95%CI: 0.16-0.80, P=0.012), preoperative prophylactic antibiotic use (OR=0.44, 95%CI: 0.24-0.78, P=0.005), and an incision length greater than the minimum tumor diameter (Difference >1-2 cm: OR=0.35, 95%CI: 0.15-0.81, P=0.015; Difference Conclusions: Diabetes, hypoproteinemia, elevated BMI, and longitudinal incisions are independent risk factors for I-SSI in laparoscopic colorectal cancer surgery, whereas elective surgery, preoperative prophylactic antibiotic use, and ensuring the incision length is greater than the minimum tumor diameter are independent protective factors. The nomogram prediction model constructed based on these factors demonstrates good predictive performance and can effectively identify patients at high risk of postoperative incision infection, providing a reference for precise clinical prevention and intervention.