A nomogram to predict stoma creation in elective surgical resection for penetrating Crohn's disease

• Published in: ANZ journal of surgery Vol. 94; no. 5; pp. 923 - 930
• Main Authors: Sun, Zhenya, Cao, Lei, Guo, Zhen, Zhou, Yan, Zhu, Weiming, Li, Yi
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.05.2024; Blackwell Publishing Ltd
• Subjects: Anastomosis; Crohn's disease; Crohns disease; Decisions; Enteral nutrition; Fistula; Fistulae; Hemoglobin; nomogram; Nomograms; Ostomy; Regression; Risk factors; stoma; Surgeons; surgery; stoma; Crohn's disease; nomogram; surgery
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.18872

Backgrounds The decision to perform a stoma during surgical resection of penetrating Crohn's disease (CD) is a critical consideration. The objective of this study was to identify factors that influence stoma creation and develop a predictive nomogram model to assist surgeons in making optimal surgical decisions. Methods A retrospective study was conducted at a tertiary center from December 1, 2012, to December 1, 2021, involving consecutive patients with penetrating CD who underwent elective surgical resection. The LASSO regression method was used to select preoperative predictors, and a nomogram was constructed using multivariate logistic regression. The performance of the nomogram was validated in an internal cohort by assessing its discrimination, calibration, and clinical usefulness. Results The study included 405 cases in the training group and 135 cases in the validation group. Nine risk factors for stoma formation were identified, including disease location, fistula resulted from previous anastomosis, absence of preoperative exclusive enteral nutrition support, albumin levels below 35 g/L, C‐reactive protein levels above 10 mg/L, hemoglobin levels below 100 g/L, perianal disease, internal fistula, and surgical approach. These risk factors were selected using the LASSO regression method, and a nomogram was developed based on them. The area under the curve and the coefficient of determination (R2) of the nomogram were 0.821 and 0.394, respectively. And the nomogram demonstrated good performance in the validation cohort. Conclusions The nomogram exhibited good predictive ability for stoma formation during elective surgical resection for penetrating CD, which can assist surgeons in making informed clinical decisions. We identified nine risk factors associated with stoma formation, including disease location, fistula resulted from previous anastomosis, absence of preoperative exclusive enteral nutrition support, albumin levels below 35 g/L, C‐reactive protein levels above 10 mg/L, hemoglobin levels below 100 g/L, perianal disease, internal fistula, and surgical approach. A nomogram was developed based on them. The area under the curve and the coefficient of determination (R2) of the nomogram were found to be 0.821 and 0.394, respectively.