Dynamic changes in the aggregate index of systemic inflammation (ΔAISI) predict postoperative complications following ileostomy closure in rectal cancer patients.

Preoperative and early postoperative albumin thresholds, rather than ΔAlb, predict severe complications after colorectal cancer surgery: a multifactorial model and nomogram

Background Postoperative complications of colorectal cancer significantly impact prognosis and healthcare burdens. While the dynamic change from preoperative to the lowest albumin level on postoperative day 2 (ΔAlb) has been linked to complications, their predictive value remains controversial. This study aims to explore the relationship between ΔAlb and postoperative complications, and evaluates a multifactorial predictive model for severe complications. Methods This retrospective study analyzed 932 patients undergoing colorectal cancer resection (August 2020–April 2022). Data included preoperative/postoperative albumin levels, demographics, surgical/anesthetic details, and 30-day complications. ΔAlb’s association with severe complications was assessed via logistic regression, and a nomogram was developed. Results Severe complications (Clavien–Dindo III–V) occurred in 14.2% of patients. ΔAlb showed no significant association with severe complications in univariate (P = 0.185) or multivariate analysis and discriminated poorly on ROC analysis (AUC 0.536, 95% CI 0.479–0.593). In the final multivariable model using clinically dichotomised predictors, preoperative albumin <35 g/L (OR 2.05, 95% CI 1.29–3.25, P = 0.003) and POD2 nadir albumin <28.5 g/L (OR 1.55, 95% CI 1.01–2.38, P = 0.044) were independent risk factors. Other independent predictors were age >65 years (OR 2.14, P = 0.003), ASA ≥3 (OR 2.14, P = 0.001), preoperative NRS2002 ≥2 (OR 1.97, P = 0.028) and rocuronium dose ≥117.5 mg (OR 4.44, P<0.001). A nomogram integrating these factors showed good discrimination (apparent C-index 0.794; optimism-corrected 0.784 by 1000-sample bootstrapping), good calibration (Hosmer–Lemeshow P = 0.72) and net clinical benefit on decision-curve analysis. Conclusion ΔAlb alone has limited predictive value, whereas absolute preoperative albumin <35 g/L and POD2 nadir albumin <28.5 g/L are independent predictors of severe complications. A multifactorial model integrating these absolute albumin thresholds with age, ASA score, preoperative NRS2002 and rocuronium dose improves prediction (optimism-corrected C-index 0.78) compared with individual factors (AUC <0.7). Because rocuronium dose may also reflect surgical complexity and perioperative management, these associations require prospective, multicentre validation.

Predicting Postoperative Complications in Patients Undergoing Surgery for Inflammatory Bowel Disease.

BACKGROUND Complications after surgery for inflammatory bowel disease (IBD) have serious short- and long-term consequences. Identifying patients at increased risk may improve outcomes. METHODS We utilized a database for patients undergoing surgery for IBD at three Danish hospitals (2017-2022). Stepwise elimination was used to fit a multivariable logistic regression model to predict the occurrence of a Clavien-Dindo postoperative complication ≥ 3B. Patients undergoing resections for Crohn's disease at another Danish hospital (2010-2020) were used for external validation. Additionally, disease-specific models were created. Predictive performance was assessed using measures of discrimination and calibration and clinical utility was assessed using decision curve analysis. RESULTS A total of 788 patients underwent bowel resection, stoma takedown or restorative proctocolectomy with ileal-pouch-anal anastomosis, with 140 (17.8%) developing a complication. Sex, ASA score, performance status, alcohol intake, diabetes, psychiatric comorbidity, preoperative systemic steroid use, and prior surgery for IBD were identified as predictors in the final model. Discrimination was modest (c-statistic 0.66, Brier score 0.13, AUPRC 0.38). In external validation of 82 Crohn's disease resections, discriminatory performance was comparable (c-statistic 0.66, Brier score 0.14, AUPRC 0.24). Disease-specific models demonstrated improved performance (Crohn's disease: c-statistic 0.74, Brier score 0.11, AUPRC 0.39; ulcerative colitis: c-statistic 0.73, Brier score 0.14, AUPRC 0.49). CONCLUSIONS Predictive performance of a general model was inferior to disease-specific models and insufficient for clinical use, and validation across the full spectrum of IBD resections, is needed to ensure generalizability. However, the model identified factors associated with postoperative morbidity, which may represent targets for prospective studies.

Development of the Novel G-CMAP Score: A Preoperative Scoring System for Predicting Postoperative Complications After Gastrectomy for Gastric Cancer.

Predictive Value of the Systemic Immune-Inflammation Index Combined With the Prognostic Nutritional Index for Flap-Related Complications Following Flap Repair in Patients With Stage Ⅲ and Ⅳ Pressure Injuries.

AIM To investigate the combined predictive value of systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) for postoperative flap-related complications in patients with stage Ⅲ and Ⅳ pressure injuries undergoing flap repair. METHODS A single-center retrospective cohort study was conducted. A total of 242 patients with stage Ⅲ and Ⅳ pressure injuries who underwent flap repair between January 2020 and December 2024 were enrolled. Based on postoperative flap-related complications, patients were divided into a non-complication group (n = 181) and a complication group (n = 61). Preoperative clinical data and laboratory parameters were collected, and SII and PNI were calculated. Independent risk factors were identified using univariate and multivariate logistic regression analyses, and a nomogram prediction model was subsequently developed. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive performance of the model. RESULTS Multivariate analysis demonstrated that PNI (odds ratio (OR) = 0.851, 95% CI: 0.793-0.913), SII (OR = 1.307, 95% CI: 1.143-1.494), and intraoperative blood loss (OR = 2.150, 95% CI: 1.141-4.052) were independent predictors of postoperative flap-related complications. The area under the curve (AUC) of the prediction model based on these three variables was 0.88 (95% CI: 0.83-0.93). The calibration curve demonstrated good agreement between predicted and observed outcomes (Hosmer-Lemeshow test, p = 0.335). CONCLUSIONS Elevated preoperative SII, reduced preoperative PNI, and increased intraoperative blood loss are independent risk factors for flap-related complications following flap repair in patients with stage Ⅲ and Ⅳ pressure injuries. The prediction model based on these three factors demonstrates good discrimination and calibration, which may facilitate perioperative risk assessment and provide a basis for individualized clinical interventions.

Postoperative day 3 geriatric nutritional risk index as an early warning marker for anastomotic leakage after colorectal cancer surgery: A retrospective cohort study

Anastomotic leakage (AL) is a serious complication after colorectal cancer (CRC) surgery, and early postoperative risk stratification remains clinically challenging. The Geriatric Nutritional Risk Index (GNRI) integrates serum albumin and body weight information, but its role as a postoperative marker and its incremental value beyond albumin alone remain uncertain. This single-center retrospective cohort study included 302 patients who underwent laparoscopic radical colorectal cancer surgery at Yanbian University Hospital between January 2022 and October 2024. Postoperative day 3 (POD3) GNRI and POD3 albumin were evaluated using receiver operating characteristic analysis, paired DeLong testing, correlation and variance inflation factor assessment, exploratory multivariable logistic models, model comparison, 1000-resample bootstrap internal validation, and colon versus rectum subgroup and interaction analyses. AL occurred in 16/302 patients (5.30%). POD3 albumin had a numerically higher area under the receiver operating characteristic curve (AUC) than POD3 GNRI (AUC: 0.744, 95% confidence interval [CI]: 0.617–0.870 vs AUC: 0.691, 95% CI: 0.597–0.785; DeLong P = .331). POD3 GNRI and POD3 albumin were correlated (Pearson R = 0.774; Spearman ρ = 0.761). The apparent AUCs were 0.766 for the clinical model, 0.793 for clinical plus POD3 albumin, and 0.801 for clinical plus POD3 GNRI; corresponding optimism-corrected AUCs were 0.680, 0.706, and 0.724. Bootstrap warnings about fitted probabilities approaching 0 or 1 indicated model instability. Low POD3 GNRI was associated with increased AL risk and may help identify patients for postoperative risk enrichment and heightened surveillance. However, POD3 GNRI should not be interpreted as having established added value beyond albumin alone, and its incremental value remains uncertain. These exploratory findings require external validation.

The relationship between preoperative systemic inflammation markers and postoperative complications in patients undergoing abdominal surgery

This study aimed to evaluate the relationship between preoperative systemic inflammation markers and postoperative complications. This study was conducted as a retrospective, single-center observational study. A total of 674 patients undergoing elective abdominal surgery under general anesthesia were included in the study. Data were collected through patient information forms, preoperative and postoperative laboratory values, and calculation of systemic inflammation markers. Independent samples t-test, Mann-Whitney U test, Pearson chi-square test, Wilcoxon test, Spearman correlation analysis, and multivariable logistic regression were used for data analysis. Data from 674 patients with a mean age of 57.17 ± 16.21 years were analyzed. Clavien-Dindo sınıflandırmasına göre hastaların %39,6’sında en az bir komplikasyon görülmüştür. A significant positive correlation was found between perioperative findings and systemic inflammation markers. Among the parameters evaluated, NLR (AUC = 0.995) and SII (AUC = 0.957) demonstrated the highest discriminative power, both remaining robust independent predictors in multivariable analysis. This study demonstrated that measuring systemic inflammation markers preoperatively could be the easiest and most cost-effective method to predict postoperative complications. Therefore, routine assessment of these parameters before surgery may aid in the early identification of patients at risk, allowing for appropriate treatment planning.