Construction and validation of risk assessment scale for postoperative gastrointestinal dysfunction after colorectal cancer surgery

Objective To develop a risk assessment scale for postoperative gastrointestinal dysfunction after colorectal cancer surgery, and test its reliability and validity, so as to provide a tool for rapid screening of high-risk patients.

Methods A pool of index items were established through literature review, and a draft of scale was formed according to the results of one round of expert meeting and two rounds of expert correspondence. The convenience sampling method was used to select 453 cases of colorectal cancer surgery patients admitted to the gastrointestinal surgery department of 3 tertiary grade A hospitals in Anhui Province. The risk of postoperative gastrointestinal dysfunction was evaluated, and the reliability and validity of scale were test, and the weight of each item was determined by analytic hierarchy process. The risk threshold of scale was determined according to the ROC curve, and the scale risk level was divided by quartile method.

Results The risk assessment scale included 27 items in 7 dimensions, including patient individual factors, tumor-related factors, combined disease and treatment history, laboratory examination factors, postoperative gastrointestinal function evaluation indicators, surgery-related factors and drug-related factors. The Cronbach's α coefficient was 0.812 and the half-reliability was 0.635. The content validity index at scale level was 0.899, and the content validity index at item level was 0.818–1.000. The confirmatory factor analysis showed the χ²/df was 1.378, and the root mean square error approximation was 0.044. The area under the receiver operating characteristic curve was 0.930 (P ＜ 0.01, 95%CI: 0.898–0.962), the risk threshold was 38 points, and the 38–47, 48–64 and ≥65 points were classified as the low risk, medium risk and high risk, respectively.

Conclusions The risk assessment scale of gastrointestinal dysfunction after colorectal cancer surgery has good reliability and validity, and can effectively identify high-risk groups of gastrointestinal dysfunction after colorectal cancer surgery, and provide an effective assessment tool for clinical management.