Development of a nomogram prediction model for postoperative intra-abdominal hypertension in patients with intra-abdominal infection sepsis based on analgesic drug selection.

BACKGROUND: Postoperative intra-abdominal hypertension (IAH) is a common complication in patients with sepsis secondary to intra-abdominal infection and is associated with organ dysfunction and prolonged intensive care unit (ICU) stay. This study aimed to identify risk factors for postoperative IAH and develop a nomogram incorporating analgesic strategy and clinical variables for early risk stratification. METHODS: This retrospective cohort study included adult patients who underwent surgery and received postoperative opioid analgesia in the ICU between June 2024 and October 2025. The primary outcome was postoperative IAH, defined as an intra-abdominal pressure >12 mmHg occurring within 48 h after initiation of postoperative opioid analgesia in the ICU. Multivariable logistic regression and LASSO regression were used to identify independent predictors, and a nomogram was subsequently developed. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. RESULTS: Among 116 patients, 49 developed IAH. Compared with patients without IAH, those with IAH were older (P = 0.027), had higher body mass index (BMI) (P = 0.006), lower albumin (P = 0.018), higher lactate (P < 0.001), and had a lower rate of oxycodone administration (P = 0.033). Multivariate analysis identified age (OR = 1.07, P = 0.011), BMI (OR = 1.21, P = 0.019), and lactate (OR = 1.22, P = 0.035) as risk factors, while oxycodone use (OR = 0.39, P = 0.033) and albumin (OR = 0.92, P = 0.011) were protective. The nomogram showed good discrimination (AUC = 0.783) and calibration. CONCLUSIONS: Advanced age, elevated BMI, and higher lactate levels were independently associated with increased odds of postoperative IAH in sepsis patients, whereas postoperative oxycodone use was independently associated with a lower odds of postoperative IAH. The nomogram may facilitate early identification of high-risk patients and guide perioperative management.