Yang Fan,Chen Zhiguo,Yue Fang,et al.Incidence of postoperative complications and early predictive factors after minimally invasive repair in children with pectus excavatum[J].Journal of Clinical Pediatric Surgery,,():268-273.[doi:10.3760/cma.j.cn101785-202505026]
Incidence of postoperative complications and early predictive factors after minimally invasive repair in children with pectus excavatum
- Keywords:
- Funnel Chest; Minimally Invasive Surgical Procedures; Postoperative Complications; Root Cause Analysis
- Abstract:
- Objective To analyze the incidence of postoperative complications in children with pectus excavatum after minimally invasive repair and to explore early predictive factors associated with postoperative complications.Methods A total of 238 children with pectus excavatum who underwent minimally invasive corrective surgery at Hebei Childrens Hospital between January 2022 and May 2025 were included in this study.According to the occurrence of complications within 3 months after surgery,the patients were divided into a complication group (n=40) and a non-complication group (n=198).Univariate analysis was performed to identify potential risk factors for postoperative complications.Variables with statistically significant differences were included in a multivariate logistic regression analysis to construct a predictive model.The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves,calibration curves,and decision curve analysis (DCA).Results Univariate analysis showed that age,severity of pectus excavatum,type of chest wall depression,number of steel bars,and Face,Legs,Activity,Cry,Consolability (FLACC) score were significantly different between the two groups (P<0.05).Multivariate logistic regression analysis showed that age (OR=1.517),severity of pectus excavatum (OR=8.754),and FLACC score (OR=7.132) were independent predictive factors of postoperative complications (P<0.05).Based on these independent risk factors,a predictive model was established as follows:Logit(P) =-15.084+0.339×age+0.979×severity of pectus excavatum+1.613×FLACC score.The calibration curve showed good agreement between predicted and observed probabilities (P=0.115).The ROC curve showed that the area under the curve (AUC) of the combined prediction model was 0.908,with a sensitivity of 80.00% and a specificity of 93.00%,indicating optimal predictive performance.The DCA curve showed that when the threshold probability ranged from 18% to 55%,the model could provide additional clinical net benefit,with the optimal threshold probability of 30%.Conclusions Children with older age,more severe pectus excavatum,and higher postoperative pain are at higher risk of postoperative complications after minimally invasive repair.The prediction model constructed based on these risk factors can help identify high-risk patients at an early stage and provide a reference for clinical decision-making.
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Memo
收稿日期:2025-5-15。
基金项目:河北省医学科学研究课题计划资助(20220730)
通讯作者:岳芳,Email:xiyurumeng@126.com