Development of a Nomogram for Predicting Postoperative Prolonged Ileus in Gastric Cancer Patients: A Retrospective and Prospective Cohort Study

Abstract

Objective

To develop and validate a nomogram for predicting the risk of postoperative prolonged ileus (PPOI) in patients undergoing gastric cancer (GC) surgery, providing a personalized risk assessment tool for early identification and optimized postoperative management.

Methods

A retrospective cohort (January 2019–December 2023) was used to develop and internally test the nomogram, while a prospective cohort (January–December 2024) was used for external validation. Univariate and multivariate logistic regression with backward stepwise selection identified independent predictors. Model performance was assessed through receiver operating characteristic (ROC) curves, calibration curves, decision-curve analysis (DCA), and clinical impact curve analysis (CICA). Patients were stratified into low, medium, and high-risk groups based on nomogram scores for further analysis.

Results

A total of 780 patients in the training cohort and 294 in the validation cohort were included, with postoperative prolonged ileus rates of 11.54% and 16.33%, respectively (χ² = 4.371, P =.037). Independent predictors included electroacupuncture, pain self-efficacy questionnaire (PSEQ) score, preoperative serum albumin (Alb), body fat, postoperative day 1 Visual Analog Scale (Pod1 VAS), and intensive care unit (ICU) admission. The nomogram demonstrated strong discriminatory ability and calibration, with clinical utility confirmed through DCA and CICA. Higher nomogram scores correlated with increased PPOI incidence.

Conclusions

The developed nomogram is a valuable tool for early identification of PPOI in GC patients, supporting clinicians and nurses in implementing personalized preventive strategies.