Construction and validation of an early weight loss predictive model of obese patients after single-anastomotic duodenal ileal bypass combined with sleeve gastrectomy

ZHANG Zhen-hua; ZHANG Zheng; HU Li-fu; XIAO Minghao; JIANG Tao

doi:10.19538/j.cjps.issn1005-2208.2024.12.17

Abstract：Objective To construct a nomogram model based on preoperative indicators to predict the early(within 1 year)weight loss effect of obese patients after single-anastomotic duodenal ileal bypass combined with sleeve gastrectomy(SADI-S)and verify it.Methods The clinical case data of obesity patients who underwent SADI-S at the China-Japan Union Hospital of Jilin University from October 2018 to March 2023 were retrospectively analyzed.After excluding patients with a history of major abdominal surgery,those who were pregnant within 1 year after surgery,those who did not make adjustments to their personal lifestyle habits in strict accordance with the requirements of our case managers after surgery,and those who were lost to follow-up,a total of 180 patients were enrolled.All patients underwent SADI-S surgery with standardized procedures.The data were randomly split into a modeling set and a validation set in a ratio of 7:3.Univariate and multivariate logistic regression analyses were performed on the 125 patients in the modeling set,and the relevant factors identified were incorporated into the nomogram model.The model was verified using Hosmer Lemeshoe goodness-of-fit test,calibration curve,ROC curve,and clinical decision curve.Results Compared to the group that did not achieve the early weight loss target,the patients in the target-achieving group had lower preoperative body mass index(BMI),waist circumference,and uric acid levels,while their fasting blood glucose and glycosylated hemoglobin levels were higher,with statistically significant differences(all P＜0.05).Multivariate logistic regression analysis showed that high BMI was an independent negative influencing factor for achieving early weight loss(OR=0.64,95％CI:0.54-0.76,P＜0.001)while high waist circumference was an independent positive influencing factor(OR=1.10,95％CI:1.03-1.17,P=0.003).The nomogram model based on these variables demonstrated good calibration and discrimination in both the modeling and validation sets,with an AUC of 0.92 in the validation set,indicating a high predictive value.Conclusion The preoperative index-based prediction model using BMI and waist circumference can effectively predict whether the early weight loss target will be achieved within 1 year after SADI-S surgery.This model helps clinicians identify obese patients who may not have optimal early weight loss outcomes and provides individualized intervention and management recommendations to improve treatment efficacy.