To construct a risk factor model for restlessness during the recovery period after general anesthesia in patients with advanced colon cancer and verify its application effect.

A total of 360 patients with advanced colon cancer admitted to Xi'an People's Hospital from March 2021 to March 2024 were prospectively included, all of them were treated with radical resection under general anesthesia, and they were divided into a training group (n=252) and a validation group (n=108) at a ratio of 7∶3. The occurrence of postoperative restlessness during the recovery period of general anesthesia was evaluated, and the clinical data of patients with and without restlessness in the training group were compared. Logistic multivariate regression analysis was used to summarize the risk factors for restlessness during the recovery period after general anesthesia in patients with advanced colon cancer. Univariate and multivariate screenings were conducted respectively to identify the key predictors, and the risk factors were incorporated into the Nomogram prediction model to establish the risk prediction model. The predictive accuracy of the model was measured using the receiver operating characteristic curve, and the calibration of the model was verified using the bootstrap method and clinical decision curve analysis (DCA).

Among the 360 patients, 102 experienced postoperative restlessness during the recovery period of general anesthesia, with an incidence rate of 28.33%. In the training group, 73 patients experienced postoperative restlessness, and the remaining 179 were without restlessness. There were statistically significant differences in age, self-rating anxiety scale (SAS) score, use of dexmedetomidine, anesthesia method, combined epidural block, intraoperative hypothermia, postoperative immobilization, and visual analogue scale (VAS) score during the recovery period between the restlessness group and the non-restlessness group (P<0.05). Logistic multivariate analysis showed that age >60 years, SAS ≥50 points, no use of dexmedetomidine, anesthesia method of general anesthesia with tracheal intubation, combined epidural block, intraoperative hypothermia, no postoperative immobilization, and VAS score ≥5 points during the recovery period were independent risk factors for postoperative restlessness during the recovery period of general anesthesia in patients with advanced colorectal cancer (P<0.05). The Nomogram model constructed based on risk factors showed good predictive efficacy in the training group and the validation group respectively, with AUCs of 0.866 (95% CI: 0.812-0.920) and 0.833 (95% CI: 0.762-0.904). Delong test indicated that there was no significant difference in AUC between the two groups (P=0.263). The sensitivity and specificity of the model in the verification group were 82.32% and 83.38%. The DCA curve further confirmed that when the threshold probability was > 30%, the clinical net benefit of the model was significantly better than the default strategy (with a 12.3% increase in net benefit), supporting its application value in actual decision-making.

Patients with advanced colon cancer have a relatively high risk of restlessness during the recovery period after general anesthesia, and it is related to factors such as age, SAS, the use of dexmedetomidine, anesthesia method, the adoption of combined epidural block, intraoperative hypothermia, postoperative immobilization, and VAS score during the recovery period. The prediction model established based on the above factors can provide a reference for the risk assessment of restlessness reduction during the recovery period after general anesthesia in patients with advanced colon cancer.