To analyze the risk factors for postoperative chemosis in patients undergoing urological retroperitoneoscopic surgery.

The clinical data of patients who received urological retroperitoneoscopic surgery in the First Hospital of Shanxi Medical University from September 2018 to December 2019 were collected and divided into chemosis group and without chemosis group according to whether postoperative chemosis occurred. Univariate and multivariate Logistic regression analysis was performed on patient-related data, ROC curves were plotted and the area under the curve (AUC) was calculated.

Among the 825 patients, 85(10.3%) had postoperative chemosis.Univariate analysis showed that compared with the control group, the proportion of renal cancer surgery was significantly higher, the intraoperative blood loss and infusion volume was significantly increased, the low angle of the jackknife head was increased, the operation time was significantly prolonged, and the CO₂ pneumoperitoneum pressure, P_ETCO₂ were significantly higher after 5 min of endotracheal intubation, after 5 min of lateral jackknife position, before restoring the supine position, at the end of pneumoperitoneum and 5 min after restoring the supine position (P<0.05). Logistic regression analysis showed that: low angle of the head in the jacket position (OR=2.967, 95%CI: 1.825 to 4.826, P<0.001), operation time (OR= 30.673, 95% CI: 3.861 to 243.676, P=0.001), CO₂ pneumoperitoneum pressure (OR=8.371, 95% CI: 3.126 to 22.418, P<0.001), and P_ETCO₂ after 5 min in the lateral jacket position (OR=1.931, 95%CI: 1.453 to 2.565, P<0.001) were independent risk factors leading to postoperative chemosis in patients. ROC curve analysis showed that: low angle of the folding knife head (AUC=0.744, P<0.001, sensitivity 0.624, specificity 0.765), operation time (AUC=0.868, P<0.001, sensitivity 0.882, specificity 0.724), CO₂ pneumoperitoneum pressure (AUC=0.855, P<0.001, sensitivity 0.765, specificity 0.818), P_ETCO₂ after 5 min of lateral recumbent folding knife position (AUC=0.818, P<0.001, sensitivity 0.906, specificity 0.612) had some diagnostic efficacy for postoperative chemosis.

Large low angle of jackknife position, long operation time, high CO₂ pneumoperitoneum pressure and high P_ETCO₂ after 5 min of lateral jackknife position are independent risk factors of chemosis after retroperitoneoscopic urological surgery.