Influencing factors of cardiovascular adverse events risk in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery and nomogram prediction model construction

Background and purpose: The establishment of artificial pneumothorax during video-assisted thoracoscopic surgery may affect the intrathoracic pressure, cause the obstruction of superior vena cava reflux, and lead to the increased risk of adverse cardiovascular events during hospitalization. However, elderly patients with esophageal cancer are more likely to have adverse cardiovascular events during the perioperative period due to the significant decline in functional status, which seriously affects the rehabilitation process. This study aimed to investigate the influencing factors of cardiovascular adverse events risk in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery and construct nomograph model to guide the formulation of clinical intervention plan. Methods: Five hundred and forty-six elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery who were treated in The First Hospital of Danjiangkou City were retrospectively chosen in the period from January 2015 to October 2020. All patients were grouped according to the occurrence of cardiovascular adverse events in perioperative period, the related clinical data were analyzed, and the independent influencing factors of cardiovascular adverse events were evaluated by logistic regression model. Based on the above factors, the nomogram prediction model was constructed and receiver operating characteristic (ROC) curve was drawn to evaluate the prediction efficiency of nomogram model. Results: Eighty-four cases (15.38%) had perioperative cardiovascular adverse events in all 546 patients. Univariate analysis showed that American Society of Anesthesiologists (ASA) grade, the number of clinical risk factors, the level of hemodynamic changes, the level of airway pressure and the level of central venous pressure (CVP) were all related to the occurrence of cardiovascular adverse events (P