Affiliation:
1. Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine Hyogo Japan
2. Division of Gastroenterology Konan Medical Center Hyogo Japan
3. Department of Endoscopy Kobe University Hospital Hyogo Japan
Abstract
ObjectivesEarly identification of patients needing hospital‐specific interventional care (HIC) following endoscopic treatment is valuable for optimizing postoperative hospital stays. We aimed to develop and validate a risk‐scoring system for predicting HIC in patients who underwent peroral endoscopic myotomy (POEM).MethodsThis study included patients with esophageal motility disorders who underwent POEM at our hospital between April 2015 and March 2023. HIC was defined as any of the following situations: fasting for gastrointestinal rest to manage adverse events (AEs); intravenous administration of medications such as antibiotics and blood transfusion; endoscopic, radiologic, and surgical interventions; intensive care unit management; or other life‐threatening events. A risk‐scoring system for predicting HIC after postoperative day (POD) 1 was developed using multivariable logistic regression and was internally validated using bootstrapping and decision curve analysis.ResultsOf the 589 patients, 50 (8.5%) experienced HIC after POD1. Risk scores were assigned for four factors as follows: age (0 points for <70 years, 1 point for 70–79 years, 2 points for ≥80 years), preoperative prognostic nutritional index (0 points for >45, 1 point for 40–45, 4 points for <40), postoperative surgical site AEs on second‐look endoscopy (7 points), and postoperative pneumonia on chest radiography (6 points). The discriminative ability (concordance statistics, 0.85; 95% confidence interval, 0.78–0.91) and calibration (slope 1.00; 0.74–1.28) were satisfactory. The decision curve analysis demonstrated its clinical usefulness.ConclusionThis risk‐scoring system can predict the HIC after POD1 and provide useful information for determining discharge.