Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.117043
Revised: January 14, 2026
Accepted: February 26, 2026
Published online: May 27, 2026
Processing time: 173 Days and 5.5 Hours
Gastrointestinal dysfunction is a common complication in elderly patients with cholelithiasis after undergoing laparoscopic cholecystectomy, and it can markedly hinder postoperative recovery. The systemic immune-inflammation index (SII) and the total cholesterol (TC)/high-density lipoprotein cholesterol ratio (HDL-C) may reflect the underlying inflammatory and metabolic states associated with postoperative outcomes. However, the combined predictive value of these two indicators remains unclear.
To develop a nomogram based on SII and TC/HDL-C for predicting poor post
In this retrospective cohort study, 123 elderly patients with cholelithiasis from Hefei BOE Hospital were included and randomly assigned to the modeling cohort (n = 86) and the validation cohort (n = 37) in a 7:3 ratio. Gastrointestinal function was evaluated 30 days after surgery. Risk factors were identified using binary logistic regression. A nomogram was then constructed, and its performance was evaluated using the area under the curve, calibration curve, and decision curve analysis.
In the modeling cohort, TC/HDL-C, SII, operation time, TC, neutrophil count, lymphocyte count, gallbladder wall thickness > 5 mm, and postoperative ambulation time ≥ 1 day were significantly higher in the poor gastrointestinal function group than in the good function group (P < 0.05). Logistic regression analysis identified TC/HDL-C [odds ratio (OR) = 1.628, 95% confidence interval (CI): 1.378-1.869], SII (OR = 3.411, 95%CI: 1.763-5.509), gallbladder wall thickness (OR = 1.524, 95%CI: 1.167-1.881), operation time (OR = 2.406, 95%CI: 1.858-2.954), and postoperative ambulation time (OR = 3.457, 95%CI: 1.109-5.805) as independent risk factors for postoperative gastrointestinal dysfunction. The area under the curves of the nomogram in the modeling and validation cohorts were 0.889 and 0.828, respectively. The calibration and decision curves indicated that the model demonstrated good consistency and clinical utility.
The nomogram model developed based on the SII and TC/HDL-C provides a reliable tool for preoperative risk stratification and may assist in guiding individualized perioperative management.
Core Tip: A nomogram was built in the current research to forecast unsatisfactory gastrointestinal performance after surgery in aged patients with gallstones. The constructed nomogram includes the systemic immune-inflammation index, the ratio of total cholesterol to high-density lipoprotein cholesterol, gallbladder wall thickness, operative duration, and the timing of ambulation after surgery. This tool showed strong predictive accuracy, with an area under the curve of 0.889 in the training cohort and 0.828 in the validation cohort. It also provided well-calibrated estimates and offered practical clinical benefit, thereby supporting the early recognition of individuals at elevated risk for the purpose of delivering focused interventions.