Risk factors of death within 30 days after thoracoscopic surgery in children with congenital dia-phragmatic hernia and establishment of a nomogram model
Objective To explore the risk factors of death within 30 days after thoracoscopic surgery in children with congenital diaphragmatic hernia(CDH),and to construct a risk nomogram predic-tion model.Methods Ninety children with congenital diaphragmatic hernia,62 males and 28 females,the age at the time of operation＜28 days,who were treated with thoracoscopic diaphragmatic hernia repair sur-gery from June 2020 to June 2023 were selected.The children were divided into two groups according to whether they survived within 30 days after surgery:survival group and death group.The predictive factors were screened by difference analysis and univariate logistic regression.The risk factors of death within 30 days after thoracoscopic diaphragmatic hernia repair surgery were analyzed by multivariate logistic regression,and the risk nomogram prediction model was constructed according to the risk factors.ROC curve,bootstrap method and decision curve were used to analyze the prediction efficiency,calibration degree and decision-making ability of the model.Results Twenty-eight(31％)children with CDH died within 30 days after thoracoscopic diaphragmatic hernia repair surgery.Multivariate Logistic regression analy-sis showed that,prenatal diagnosis time ≤ 25 weeks,low birth weight infants,preoperative high-frequency oscillatory ventilation(HFOV),preoperative oxygenation index(OI),open surgery,liver hernia into the thoracic cavity was an independent risk factor of death within 30 days after surgery in children with CHD(P＜0.05).Based on the above independent risk factors,a nomogram prediction model for the risk of death in children with CDH was constructed.ROC analysis showed that the AUC of the model was 0.959(95％CI 0.9107-1.0000).When cut-off value=0.361,the sensitivity was 92.9％,the specificity was 91.9％,and the Youden index was 0.848.The C-index was 0.917,indicating that the model has good pre-diction ability.The decision-making curve showed that the threshold probability of the model ranges from 0.01 to 1.00,and its net return＞0,which was higher than the two invalid lines.Conclusion Prenatal diagnosis time≤25 weeks,low birth weight infants,preoperative HFOV,preoperative OI increase,open surgery,liver hernia into the chest are the independent risk factors of postoperative death in children with congenital diaphragmatic hernia.The nomogram prediction model constructed based on this has good predic-tive value for postoperative death in children with congenital diaphragmatic hernia.
万方数据
维普
