Development and validation of a nomogram prediction model for patient selection in emergency day surgery of laparoscopic appendectomy based on preoperative and intraoperative immediate indicators

DU Kaifang; LANG Guiling; WANG Xichun; WEI Lei; ZHAO Changzhi; FENG Zhongyi; CHENG Mingjie; LI Hanshuo

doi:10.16016/j.2097-0927.202601114

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Development and validation of a nomogram prediction model for patient selection in emergency day surgery of laparoscopic appendectomy based on preoperative and intraoperative immediate indicators

Monographic Reports | 更新时间：2026-07-15

- Development and validation of a nomogram prediction model for patient selection in emergency day surgery of laparoscopic appendectomy based on preoperative and intraoperative immediate indicators
- Journal of Army Medical University Vol. 48, Issue 13, Pages: 1846-1853(2026)
- 作者机构：
  
  大连医科大学附属大连市友谊医院肝胆外科，大连市肝胆外科研究所，辽宁大连
- 作者简介：
  
  DU Kaifang， E-mail：Dr.dukfang@foxmail.com
  LANG Guiling， E-mail：langguiling2012@163.com
- 基金信息：
  
  the Project of Scientific Research Fund of Dalian Municipal Friendship Hospital(FH2023029)
- DOI：10.16016/j.2097-0927.202601114
  CLC： R181.23;R197.323;R656.8
- Received：27 January 2026，
  
  Revised：2026-03-16，
  
  Accepted：24 March 2026，
  
  Published：15 July 2026
- 稿件说明：
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杜开放，郎桂玲，王希春，等.基于术前-术中指标构建急诊日间腹腔镜阑尾切除术患者筛选列线图预测模型及验证［J］.陆军军医大学学报，2026，48（13）：1846-1853.DOI：10.16016/j.2097-0927.202601114.

DU K F，LANG G L，WANG X C，et al.Development and validation of a nomogram prediction model for patient selection in emergency day surgery of laparoscopic appendectomy based on preoperative and intraoperative immediate indicators［J］.J Army Med Univ，2026，48（13）：1846-1853.DOI：10.16016/j.2097-0927.202601114.
杜开放，郎桂玲，王希春，等.基于术前-术中指标构建急诊日间腹腔镜阑尾切除术患者筛选列线图预测模型及验证［J］.陆军军医大学学报，2026，48（13）：1846-1853.DOI：10.16016/j.2097-0927.202601114. DOI：

DU K F，LANG G L，WANG X C，et al.Development and validation of a nomogram prediction model for patient selection in emergency day surgery of laparoscopic appendectomy based on preoperative and intraoperative immediate indicators［J］.J Army Med Univ，2026，48（13）：1846-1853.DOI：10.16016/j.2097-0927.202601114. DOI：

摘要

目的

部分急性阑尾炎（acute appendicitis，AA）患者可在急诊腹腔镜阑尾切除术（laparoscopic appendectomy，LA）后实现日间出院，但目前临床缺乏客观、量化的筛选工具。本研究基于术前及术中临床指标，构建预测AA患者行急诊日间LA的列线图预测模型，为临床筛选日间手术的患者提供参考依据。

方法

本研究为单中心回顾性队列研究。收集2021年12月至2023年12月大连医科大学附属大连市友谊医院普通外科、肝胆外科急诊行LA的AA患者218例。根据住院时间分为日间组（住院时间≤48 h，78例）和常规组（住院时间48 h，140例）。比较2组基线资料、术中情况及术后恢复情况。对差异具有统计学意义的术前及术中变量采用最小绝对收缩和选择算子（least absolute shrinkage and selection operator，LASSO）回归筛选特征变量，并通过多因素Logistic回归分析构建列线图预测模型。采用ROC曲线评估模型区分度，绘制校准曲线评价模型校准度，并通过决策曲线分析（decision curve analysis，DCA）评估模型的临床实用性。

结果

与常规组相比，日间组住院费用更低（

0.05），2组在术后并发症、出院3 d再就诊率、出院30 d再就诊率及再手术率方面差异均无统计学意义。单因素分析显示，2组在年龄、查尔森共病指数（Charlson comorbidity index，CCI）、发病时间、腹膜炎、白细胞计数、C-反应蛋白、阑尾直径、阑尾穿孔、手术时间及腹腔引流管放置方面的差异均有统计学意义（

均0.05）。经LASSO回归筛选并纳入多因素Logistic回归分析，结果显示年龄（

=0.444，95%

：0.206~0.955，

0.05）、C-反应蛋白（

=0.072，95%

：0.030~0.176，

0.001）、腹膜炎（

=0.448，95%

：0.201~0.999，

=0.050）及手术时间（

=0.230，95%

：0.107~0.496，

0.001）为急诊日间腹腔镜阑尾切除术的独立保护性相关因素。基于上述4个变量构建列线图预测模型。ROC曲线分析显示模型AUC为0.864（95%

：0.812~0.916），提示模型具有良好的区分能力；校准曲线显示模型预测概率与实际发生率具有较好一致性；DCA结果表明该模型具有较好的临床净获益。

结论

急诊日间LA用于部分AA患者安全可行。基于年龄、C-反应蛋白、腹膜炎及手术时间构建的列线图预测模型具有良好的区分度、校准度及临床实用性，可为外科医师筛选适宜行急诊日间LA的患者提供量化参考依据。

Abstract

Objective

Some patients with acute appendicitis(AA) may be discharged in day surgery mode after emergency laparoscopic appendectomy(LA). However

objective and quantitative screening tools are currently lacking in clinical practice. This study aims to develop a nomogram prediction model for day emergency surgery of LA in AA patients based on preoperative and intraoperative clinical variables

thereby providing a reference basis for clinical patient selection for day surgery.

Methods

A single-center retrospective cohort study was conducted on 218 AA patients who underwent emergency day surgery of LA in our department between December 2021 and December 2023. Based on the length of hospital stay

the patients were divided into a day surgery group(≤48 h) and a conventional group(48 h). Baseline characteristics

intraoperative status

and postoperative recovery were compared between the 2 groups. Preoperative and intraoperative variables with statistical differences were subjected to least absolute shrinkage and selection operator(LASSO) regression for feature selection

and a nomogram prediction model was constructed by multivariable logistic regression analysis. The discrimination

calibration

and clinical utility of the model were evaluated using receiver operating characteristic(ROC) curve

calibration plot

and decision curve analyses

respectively.

Results

Compared with the conventional group

the day surgery group had significantly lower hospitalization costs(

0.05)

with no significant differences between them in the proportions of postoperative complications

3-day and 30-day readmission rates

or reoperation rates. Univariate analysis revealed significant differences between the 2 groups in terms of age

Charlson comorbidity index(CCI)

duration of disease peritonitis

white blood cell count

C-reactive protein(CRP)

appendiceal diameter

appendiceal perforation

operative time

and intra-abdominal drainage tube placement(all

0.05). LASSO regression screening and multivariable logistic regression analysis indicated that age(

=0.444

95%

: 0.206 to 0.955

0.05)

CRP(

=0.072

95%

: 0.030 to 0.176

0.001)

peritonitis(

=0.448

95%

: 0.201 to 0.999

=0.050)

and operative time(

=0.230

95%

: 0.107 to 0.496

0.001) were independent protective factors associated with emergency day surgery of LA. A nomogram prediction model was constructed based on these 4 variables. ROC curve analysis showed the model yielded an AUC value of 0.864(95%

: 0.812 to 0.916)

with favorable discriminatory ability

good consistency between predicted probabilities and actual occurrence rates

and sound clinical net benefit.

Conclusion

Emergency day surgery of LA is a safe and feasible option for selected patients with AA. Our constructed prediction model based on age

CRP

peritonitis

and operative time demonstrates favorable discrimination

calibration

and clinical utility

and may provide a quantitative reference for surgeons to select appropriate candidates for emergency day surgery of LA.

关键词

Keywords

references

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