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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Predicting prolonged postoperative ileus in gastric cancer patients based on bowel sounds using intelligent auscultation and machine learning
Shuai Shi, Cong Lu, Liang Shan, Liang Yan, Yong Liang, Tao Feng, Zun Chen, Xin Chen, Xi Wu, Si-Da Liu, Xiang-Long Duan, Ze-Zheng Wang
Shuai Shi, Liang Shan, Tao Feng, Zun Chen, Xi Wu, Si-Da Liu, Xiang-Long Duan, Ze-Zheng Wang, Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
Cong Lu, Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Liang Yan, Institute of Navigation, Northwestern Polytechnical University, Xi’an 710072, Shaanxi Province, China
Yong Liang, Electronics and Information Engineering, Xi'an Polytechnic University, Xi’an 710048, Shaanxi Province, China
Xin Chen, Xiang-Long Duan, Department of Medicine, Xi'an Jiao Tong University, Xi’an 710065, Shaanxi Province, China
Xiang-Long Duan, Shaanxi Engineering Research Center of Medical Polymer Materials, Xi’an 710072, Shaanxi Province, China
Xiang-Long Duan, Institute of Medical Research, Northwestern Polytechnical University, Xi’an 710072, Shaanxi Province, China
Co-first authors: Shuai Shi and Cong Lu.
Co-corresponding authors: Xiang-Long Duan and Ze-Zheng Wang.
Author contributions: Duan XL, Shi S, Yan L, Liang Y and Wang ZZ designed the research; Duan XL, Shi S, Feng T, Chen Z, Shan L, Chen X, Wu X, Liu SD and Wang ZZ collected the data; Duan XL, Shi S, Feng T, Chen Z, Shan L, Chen X, and Wu X performed the data analysis; Shi S and Wang ZZ wrote the paper. Shi S and Lu C contributed equally to this work as co-first authors. Designating two individuals as co-corresponding authors is warranted by their equally substantial and complementary contributions to this research project. Both authors were instrumental in the study's conception, design, data analysis, and interpretation. Their collaborative efforts extended to manuscript preparation, revisions, and handling complex issues during peer review. To be specific, Wang ZZ assumed the majority of the writing tasks of revising. However, all revisions and responses were managed collaboratively by both corresponding authors. Sharing the corresponding author role reflects their joint leadership and commitment throughout the research process. This designation ensures that all inquiries related to the study are addressed by either author, highlighting their mutual responsibility and dedication to the work’s integrity and dissemination.
Supported by Key Research and Development Program of Shaanxi, No. 2020GXLH-Y-019, No. 2022KXJ-141, and No. 2023-GHYB-11; Innovation Capability Support Program of Shaanxi, No. 2019GHJD-14 and No. 2021TD-40; and Science and Technology Program of Xi'an, No. 23ZDCYJSGG0037-2022.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Shaanxi Provincial People's Hospital (Ethics number: SPPH-LLBG-17-32).
Informed consent statement: All the individuals who participated in this study provided their written informed consent prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xiang-Long Duan, MD, PhD, Chief Doctor, Professor, Second Department General Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi East Road, Xi’an 710068, Shaanxi Province, China.
duanxianglong@nwpu.edu.cn
Received: July 10, 2024
Revised: August 27, 2024
Accepted: September 10, 2024
Published online: November 27, 2024
Processing time: 112 Days and 2 Hours
BACKGROUND
Prolonged postoperative ileus (PPOI) delays the postoperative recovery of gastrointestinal function in patients with gastric cancer (GC), leading to longer hospitalization and higher healthcare expenditure. However, effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of the lack of noninvasive methods.
AIM
To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected via an intelligent auscultation system to guide clinical practice.
METHODS
This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021. Among them, PPOI was reported in 33 cases. The patients were randomly divided into the training and validation cohorts. Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model.
RESULTS
The analysis identified six potential variables associated with PPOI among the included participants. The incidence rate of PPOI was 27.5%. Age ≥ 70 years, cTNM stage (I and IV), preoperative hypoproteinemia, recovery time of bowel sounds (RTBS), number of bowel sounds (NBS), and frequency of bowel sounds (FBS) were independent risk factors for PPOI. The Bayesian model demonstrated good performance with internal validation: Training cohort [area under the curve (AUC) = 0.880, accuracy = 0.823, Brier score = 0.139] and validation cohort (AUC = 0.747, accuracy = 0.690, Brier score = 0.215). The model showed a good fit and calibration in the decision curve analysis, indicating a significant net benefit.
CONCLUSION
PPOI is a common complication following gastrectomy in patients with GC and is associated with age, cTNM stage, preoperative hypoproteinemia, and specific bowel sound-related indices (RTBS, NBS, and FBS). To facilitate early intervention and improve patient outcomes, clinicians should consider these factors, optimize preoperative nutritional status, and implement routine postoperative bowel sound monitoring. This study introduces an accessible machine learning model for predicting PPOI in patients with GC.
Core Tip: Postoperative recovery of gastrointestinal function in patients with gastric cancer (GC) is crucial. However, it is frequently delayed by prolonged postoperative ileus, leading to increased hospital stays and economic burdens. Effective monitoring of postoperative gastrointestinal recovery in patients with GC remains challenging due to the lack of noninvasive methods. This study investigated risk factors for delayed postoperative bowel function recovery and evaluated bowel sound indicators collected via an intelligent auscultation system to guide clinical practice.
