Construction and validation of a risk model of cervical adhesions after cervical loop electrosurgical excision procedure

Abstract:

Objective To analyze risk factors for cervical adhesions after loop electrosurgical excision procedure（LEEP） of the cervix，and to establish and verify a risk prediction model for it.Methods We prospectively selected 200 patients with cervical squamous intraepithelial lesions（SILs） who received LEEP treatment in The First People’s Hospital of Zunyi from September 2021 to April 2022. According to the presence or absence of cervical adhesions after LEEP，they were divided into adhesion group（n=45） and non-adhesion group（n=155）. Univariable and multivariable logistic regression analyses were performed to determine risk factors for the occurrence of postoperative cervical adhesions. A nomogram model was established based on the selected risk factors，followed by accuracy verification.Results The independent risk factors for postoperative cervical adhesions included age［odds ratio（OR）=1.152，95%CI=1.063-1.249］，cervical wound bleeding（OR=6.602，95%CI=2.652-16.436），cervical wound infection（OR=6.288，95%CI=2.357-16.772），and the depth of excision（OR=3.383，95%CI=1.367-8.373）. The verification results showed that the CI was 0.904. The Hosmer-Lemeshow test showed no significant difference between the nomogram model-predicted value and the observed value of the risk of cervical adhesions after LEEP（χ²=1.810，P=0.840）. For predicting the occurrence of cervical adhesions after LEEP，the calibration curve of the nomogram model was close to the ideal curve，with the mean absolute error before and after verification being 0.033. The area under the receiver operating characteristic curve of the nomogram model predicting the occurrence of postoperative cervical adhesions was 0.904（95%CI=0.858-0.950），with a sensitivity of 0.933 and a specificity of 0.768.Conclusion The established risk prediction model performs well in predicting the occurrence of cervical adhesions in patients with SILs undergoing LEEP，which can provide a reference for early preventive intervention measures for these patients.