Zhang Jinwei,Su Jun,Wu Shuihua,et al.Influencing factors for treatment failure within 30 days post-hydrocephalus surgery in children and developing a risk prediction model[J].Journal of Clinical Pediatric Surgery,,():249-255.[doi:10.3760/cma.j.cn101785-20251028-00022]
Influencing factors for treatment failure within 30 days post-hydrocephalus surgery in children and developing a risk prediction model
- Keywords:
- Hydrocephalus; Ventriculostomy; Prognosis; Root Cause Analysis
- Abstract:
- Objective To identify the risk factors for treatment failure within 30 days after surgery in children with hydrocephalus and develop a clinically applicable individualized prediction model.Methods We retrospectively analyzed 326 children undergoing initial operation (VPS/ETV) from July 2016 to September 2025 at a tertiary center.Primary outcome was treatment failure within 30 days.Candidate variables were screened by univariate tests and entered into multivariable Logistic regression,including an interaction term between surgical procedure and etiology.A nomogram was constructed from significant predictors.Model performance was assessed by area under the ROC curve (AUC),calibration curve with Hosmer-Lemeshow test,1,000-bootstrap internal validation and decision curve analysis (DCA).Results The 30-day failure rate was 20.86%(68/326).Independent predictors included severe ventriculomegaly (FOHR ≥0.60;OR=3.826,95%CI:2.154-6.798),infection-related etiology (OR=3.215,95%CI:1.732-5.976),hemorrhage-related etiology (OR=2.783,95%CI:1.462-5.297) and ETV versus VPS (OR=2.517,95%CI:1.389-4.558).Significant interaction indicated that,in infection-or hemorrhage-related hydrocephalus,ETV carried ~2.5-fold higher early failure risk than VPS,whereas no difference existed for congenital/malformative,cystic,traumatic or tumor-related etiologies.The nomogram achieved an AUC of 0.831 (95%CI:0.744-0.919) with good calibration (Hosmer-Lemeshow χ2=6.328,P=0.610).DCA indicated net clinical benefit across threshold probabilities of ~8%-45%.Conclusions Etiology,surgical choice and preoperative ventricular size are key determinants of early postoperative failure after operation for pediatric hydrocephalus.FOHR-,etiology- and procedure-based nomogram has demonstrated solid discrimination and calibration.
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Memo
收稿日期:2025-10-28。
基金项目:湖南省自然科学基金(2025JJ50682);湖南省卫生健康科研课题(20255490)
通讯作者:吴水华,Email:292454021@qq.com