老年腹腔镜结直肠癌根治术患者术后发生谵妄的影响因素及列线图评估模型构建OA

Objective To explore the influencing factors of postoperative delirium in elderly patients under-going laparoscopic radical resection of colorectal cancer,and to construct a nomogram evaluation model for the risk of postoperative delirium.Methods A total of 156 elderly patients undergoing laparoscopic radical resec-tion of colorectal cancer in the hospital from January 2022 to January 2025 were selected as the research ob-jects.According to whether delirium occurred after surgery,the patients were divided into the delirium group and the non-delirium group.The delirium group and the non-delirium group were matched 1∶1 by propensity score matching method.Multivariate Logistic regression was used to analyze the influencing factors of postop-erative delirium in elderly patients undergoing laparoscopic radical resection of colorectal cancer.The"rms"package of R4.4.3 software was used to visualize the model and construct the nomogram model.The receiver operating characteristic(ROC)curve,Hosmer-Lemeshow goodness-of-fit test,calibration curve and decision curve were used to evaluate the discrimination,fitting,calibration ability and clinical benefit.Results Before matching,the age of the delirium group was greater than that of the non-delirium group,and the preoperative nutritional score,hemoglobin and albumin levels,and lymphocyte percentage were lower than those of the non-delirium group,and the neutrophil percentage and white blood cell count were higher than those of the non-delirium group,and the operation time was longer than that of the non-delirium group,and the differences were all statistically significant(P<0.05).After matching,the age of the delirium group was greater than that of the non-delirium group,and the preoperative nutritional score,hemoglobin and albumin levels,and lymphocyte percentage were all lower than those of the non-delirium group,and the neutrophil percentage and white blood cell count were higher than those of the non-delirium group,and the operation time was longer than that of the non-delirium group,and the differences were all statistically significant(P<0.05).Multivari-ate Logistic regression analysis showed that age,preoperative albumin,preoperative hemoglobin and operation time were the influencing factors of postoperative delirium in elderly patients undergoing laparoscopic colorec-tal cancer surgery(P<0.05).The area under the curve(AUC)of the nomogram evaluation model based on the above 4 factors was 0.937(95%CI:0.893-0.980),indicating that the model had good discrimination.The calibration curve analysis showed that the predicted probability was in good agreement with the actual in-cidence.Decision curve analysis showed that the model had good clinical practicability.Conclusion Age,pre-operative albumin,preoperative hemoglobin and operation time are the influencing factors of postoperative de-lirium in elderly patients undergoing laparoscopic colorectal cancer surgery.The nomogram model based on this model has good evaluation efficiency,which can be used to assess the risk of postoperative delirium indi-vidually,and is helpful for early clinical screening and intervention.