| Application of competitive risk model in the analysis of risk and influencing factors of parastomal hernia |
| Received:July 07, 2021 Revised:September 24, 2021 Click here to download the full text |
| Citation of this paper:DING Min,WU Yan,GAO Jian,QI Bi-rong,SUN Yi,PU Jing-zhi.Application of competitive risk model in the analysis of risk and influencing factors of parastomal hernia[J].Chinese Journal of Clinical Medicine,2022,29(2):190-199 |
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| Author Name | Affiliation | E-mail | | DING Min | Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | WU Yan | Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China | wu.yan@zs-hospital.sh.cn | | GAO Jian | Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | QI Bi-rong | Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | SUN Yi | Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | PU Jing-zhi | Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China | |
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| Abstract:Objective To evaluate the risk and influencing factors of parastomal hernia (PSH) by competitive risk model. Methods Clinical data of 735 patients with enterostomy from 2015 to 2019 were analyzed retrospectively. The cumulative incidence of PSH was evaluated by Cox model. When death and reversal occurred as competitive events, Fine-Gray model was used for analysis. Results During the median follow-up of 17.1 months, 136 cases (18.5%) developed PSH, and the median time of PSH was 10 months. Univariate Cox regression analysis and univariate gray test showed that age, preoperative body mass index (BMI), hypertension, prostate hypertrophy and stoma pathway were related to the occurrence of PSH. Multivariate Cox regression analysis and multivariate Fine-Gray model showed that age≥60 years old, preoperative BMI≥25 kg/m2 and extraperitoneal stoma were independent influencing factors of PSH. In addition, the multivariate Fine-Gray model showed that sigmoid colostomy was also an independent influencing factor of PSH. When Kaplan-Meier method was used, the cumulative incidence of PSH in patients with enterostomy were 20.5%, 29.8% and 37.6%, respectively; when using Fine-Gray model, they were 13.69%, 20.07% and 25.31% respectively. Compared with Kaplan-Meier or Cox method, the estimation of cumulative incidence of PSH by Fine-Gray model was always low. Conclusion In the case of competitive risk, compared with Kaplan-Meier and Cox models, Fine-Gray model can more accurately evaluate the high-risk factors related to the occurrence of PSH and the cumulative incidence of PSH. These results may provide reference value for clinical medical staff to evaluate the occurrence of PSH more objectively. |
| keywords:parastomal hernia Cox model competitive risk model Fine-Gray model |
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