Risk factors and prediction model for early high-output stoma after colorectal cancer surgery: A retrospective study

Objective This retrospective cohort study aimed to identify independent risk factors for early high-output stoma (HOS) following colorectal cancer (CRC) surgery and to construct and validate a predictive nomogram. Methods Consecutive patients who underwent ileostomy for CRC at a tertiary hospital were enrolled. The cohort was divided into a training set ( n = 470; January–December 2024) and a temporal validation set ( n = 187; January–May 2025). Multivariable logistic regression was performed to identify independent predictors and construct the nomogram. Model performance was evaluated in terms of discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and clinical utility using decision curve analysis (DCA). Results The overall incidence of early HOS was 27.7%. Independent predictors included sex, age, alcohol consumption, use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), intestinal obstruction, serum albumin level, leukocytosis, and serum calcium level (all P < 0.05). The nomogram demonstrated excellent discrimination, with AUCs of 0.906 in the training set and 0.888 in the validation set. Calibration and DCA indicated good agreement and favorable clinical utility. Conclusions The proposed nomogram shows strong predictive performance and potential clinical applicability. It enables early risk stratification, thereby supporting targeted surveillance and individualized postoperative management for patients at high risk of HOS.