Risk factors and nomogram for predicting delayed gastrointestinal recovery after radical gastrectomy

Table 1 Comparison of general information and preoperative laboratory indicators between two groups, n (%)/mean ± SD

Item	Normal gastrointestinal recovery group (n = 218)	Delayed gastrointestinal recovery group (n = 75)	Statistic	P value
Gender			χ2 = 4.366	0.037
Male	151 (69.3)	42 (56.0)
Female	67 (30.7)	33 (44.0)
Age (years)	64.7 ± 11.3	68.6 ± 10.2	t = 2.771	0.006
BMI classification			χ2 = 6.847	0.032
Underweight	28 (12.8)	18 (24.0)
Normal	105 (48.2)	32 (42.7)
Overweight	52 (23.9)	16 (21.3)
Obese	33 (15.1)	9 (12.0)
Smoking history	89 (40.8)	36 (48.0)	χ2 = 1.200	0.273
Alcohol consumption history	67 (30.7)	28 (37.3)	χ2 = 1.102	0.293
Comorbidities
Hypertension	78 (35.8)	32 (42.7)	χ2 = 1.132	0.287
Diabetes	38 (17.4)	22 (29.3)	χ2 = 4.124	0.042
Coronary heart disease	23 (10.6)	11 (14.7)	χ2 = 0.952	0.329
COPD	15 (6.9)	8 (10.7)	χ2 = 1.115	0.291
Cirrhosis	12 (5.5)	6 (8.0)	χ2 = 0.630	0.427
Previous abdominal surgery	34 (15.6)	16 (21.3)	χ2 = 1.350	0.245
ASA classification			χ2 = 7.528	0.006
Grade I-II	171 (78.4)	47 (62.7)
Grade III	47 (21.6)	28 (37.3)
Preoperative anemia	56 (25.7)	30 (40.0)	χ2 = 5.685	0.017
Preoperative hypoalbuminemia	42 (19.3)	27 (36.0)	χ2 = 8.715	0.003
Abnormal serum sodium	18 (8.3)	9 (12.0)	χ2 = 0.945	0.331
Abnormal serum potassium	22 (10.1)	11 (14.7)	χ2 = 1.188	0.276
Abnormal fasting blood glucose	35 (16.1)	17 (22.7)	χ2 = 1.727	0.189
Elevated CEA	73 (33.5)	29 (38.7)	χ2 = 0.668	0.414
Elevated CA19-9	65 (29.8)	27 (36.0)	χ2 = 1.021	0.312

COPD: Chronic obstructive pulmonary disease; ASA: American Society of Anesthesiologists; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9.

Table 2 Comparison of tumor-related data between two groups, n (%)

Item	Normal gastrointestinal recovery group (n = 218)	Delayed gastrointestinal recovery group (n = 75)	Statistic	P value
Tumor location			χ2 = 1.862	0.426
Upper gastric	58 (26.6)	23 (30.7)
Middle gastric	47 (21.6)	18 (24.0)
Lower gastric	92 (42.2)	27 (36.0)
Diffuse type	21 (9.6)	7 (9.3)
Maximum tumor diameter (cm)	4.2 ± 1.8	5.1 ± 2.1	t = 3.521	0.031
Lauren pathological type			χ2 = 0.324	0.518
Intestinal	98 (45.0)	31 (41.3)
Diffuse	87 (39.9)	32 (42.7)
Mixed	33 (15.1)	12 (16.0)
Degree of differentiation			χ2 = 7.918	0.019
Well-differentiated	32 (14.7)	6 (8.0)
Moderately differentiated	95 (43.6)	24 (32.0)
Poorly/undifferentiated	91 (41.7)	45 (60.0)
TNM staging			χ2 = 8.284	0.004
Stage I-II	128 (58.7)	30 (40.0)
Stage III	90 (41.3)	45 (60.0)

TNM: Tumour, node, and metastasis.

Table 3 Comparison of surgery-related data between two groups, n (%)/mean ± SD/median (interquartile range)

Item	Normal gastrointestinal recovery group (n = 218)	Delayed gastrointestinal recovery group (n = 75)	Statistic	P value
Surgical procedure			χ2 = 12.348	0.002
Distal subtotal gastrectomy	128 (58.7)	31 (41.3)
Proximal subtotal gastrectomy	51 (23.4)	18 (24.0)
Total gastrectomy	39 (17.9)	26 (34.7)
Surgical approach			χ2 = 3.976	0.046
Laparoscopic	147 (67.4)	41 (54.7)
Open	71 (32.6)	34 (45.3)
Operative time (minute)	218.6 ± 52.3	257.4 ± 61.8	t = 4.982	< 0.001
Intraoperative blood loss (mL)	180 (120-250)	250 (180-350)	Z = 3.327	0.001
Extent of lymph node dissection			χ2 = 4.900	0.027
D1/D1+	56 (25.7)	10 (13.3)
D2	162 (74.3)	65 (86.7)
Combined organ resection	24 (11.0)	18 (24.0)	χ2 = 7.038	0.008
Reconstruction method			χ2 = 10.135	0.035
Billroth I	68 (31.2)	15 (20.0)
Billroth II	42 (19.3)	12 (16.0)
Roux-en-Y (gastrojejunal)	57 (26.1)	22 (29.3)
Esophagogastric anastomosis	32 (14.7)	10 (13.3)
Esophagojejunal (Roux-en-Y)	19 (8.7)	16 (21.3)

Table 4 Comparison of postoperative data between two groups, n (%)/median (interquartile range)

Item	Normal gastrointestinal recovery group (n = 218)	Delayed gastrointestinal recovery group (n = 75)	Statistic	P value
Postoperative abdominal drainage	203 (93.1)	72 (96.0)	χ2 = 0.811	0.368
Drainage tube retention time (day)	4 (3-5)	5 (4-6)	Z = 1.740	0.082
Time to first postoperative ambulation (hour)	24 (18-30)	36 (30-48)	Z = 5.824	< 0.001
Time to first liquid diet intake (hour)	48 (36-60)	72 (60-96)	Z = 3.092	0.002
Postoperative analgesia method			χ2 = 6.412	0.041
PCIA	127 (58.3)	35 (46.7)
PCEA	68 (31.2)	28 (37.3)
Conventional analgesia	23 (10.6)	12 (16.0)
Overall postoperative complications	38 (17.4)	31 (41.3)	χ2 = 17.865	< 0.001
Pulmonary infection	15 (6.9)	12 (16.0)
Wound infection	8 (3.7)	6 (8.0)
Abdominal infection	6 (2.8)	5 (6.7)
Anastomotic leakage	4 (1.8)	3 (4.0)
Bleeding	3 (1.4)	3 (4.0)
Pancreatic fistula	2 (0.9)	2 (2.7)

PCIA: Patient-controlled intravenous analgesia; PCEA: Patient-controlled epidural analgesia.

Table 5 Univariate logistic regression analysis of factors influencing delayed gastrointestinal recovery

Variable	β	SE	Wald χ2	OR	95%CI	P value
Female gender	0.574	0.266	4.662	1.78	1.06-2.98	0.031
Age ≥ 65 years	0.612	0.265	5.338	1.84	1.10-3.09	0.021
Underweight	0.761	0.33	5.322	2.14	1.12-4.09	0.021
Diabetes	0.648	0.296	4.789	1.91	1.07-3.42	0.029
ASA grade III	0.803	0.272	8.721	2.23	1.31-3.81	0.003
Preoperative anemia	0.643	0.278	5.344	1.9	1.10-3.29	0.021
Preoperative hypoalbuminemia	0.852	0.283	9.07	2.34	1.35-4.07	0.003
Maximum tumor diameter ≥ 5 cm	0.573	0.264	4.705	1.77	1.06-2.97	0.03
Poorly/undifferentiated	0.689	0.274	6.319	1.99	1.16-3.41	0.012
TNM stage III	0.774	0.266	8.475	2.17	1.29-3.65	0.004
Proximal subtotal gastrectomy	0.512	0.335	2.337	1.67	0.87-3.21	0.126
Total gastrectomy	1.085	0.288	14.189	2.96	1.68-5.21	< 0.001
Open surgery	0.685	0.266	6.638	1.98	1.18-3.34	0.01
Operative time ≥ 240 minute	0.692	0.267	6.723	2	1.18-3.38	0.01
Intraoperative blood loss ≥ 200 mL	0.721	0.268	7.233	2.06	1.22-3.48	0.007
D2 Lymph node dissection	0.598	0.346	2.988	1.82	0.92-3.59	0.084
Combined organ resection	0.826	0.311	7.048	2.28	1.24-4.20	0.008
Billroth II	0.186	0.398	0.219	1.2	0.55-2.64	0.64
Roux-en-Y (gastrojejunal)	0.445	0.368	1.463	1.56	0.76-3.21	0.226
Esophagogastric anastomosis	0.291	0.428	0.462	1.34	0.58-3.10	0.497
Esophagojejunal (Roux-en-Y)	1.092	0.398	7.524	2.98	1.37-6.49	0.006

ASA: American Society of Anesthesiologists.

Table 6 Multivariate logistic regression analysis of factors influencing delayed gastrointestinal recovery

Variable	β	SE	Wald χ2	OR	95%CI	P value
Age ≥ 65 years	0.779	0.33	5.575	2.18	1.14-4.17	0.018
Underweight	1.054	0.374	7.953	2.87	1.38-5.97	0.005
ASA grade III	0.884	0.326	7.35	2.42	1.28-4.58	0.007
Preoperative hypoalbuminemia	0.928	0.336	7.621	2.53	1.31-4.89	0.006
TNM stage III	0.765	0.325	5.542	2.15	1.14-4.06	0.018
Total gastrectomy	1.188	0.35	11.509	3.28	1.65-6.52	0.001

ASA: American Society of Anesthesiologists; TNM: Tumour, node, and metastasis.