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,2026,(03):268-273.[doi:10.3760/cma.j.cn101785-202505026]
漏斗胸患儿微创矫正术后并发症分析及早期预测因素分析
- Title:
- 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
- 摘要:
- 目的 分析漏斗胸患儿微创矫正术后并发症发生情况,探究术后并发症相关的早期预测因素。方法 选取2022年1月至2025年5月于河北省儿童医院接受微创矫正手术的238例漏斗胸患儿为研究对象,根据术后3个月内并发症发生情况分为有并发症组(n=40)和无并发症组(n=198)。采用单因素分析筛选并发症相关风险因素,将差异有统计学意义的指标纳入多因素Logistic回归分析,构建预测模型;通过受试者操作特征(receiver operating characteristic,ROC)曲线、校准曲线及决策曲线分析(decision curve analysis,DCA)评估模型预测价值。结果 单因素分析显示,年龄、漏斗胸严重程度、胸壁凹陷类型、钢板数量、儿童疼痛行为量表(FLACC)评分在两组间比较差异有统计学意义(P<0.05);多因素Logistic回归分析表明,年龄(OR=1.517)、漏斗胸严重程度(OR=8.754)、FLACC评分(OR=7.132)是术后并发症的独立预测因素(P<0.05)。基于上述独立危险因素构建预测模型,公式为Logit(P)=-15.084+0.339×年龄+0.979×漏斗胸严重程度+1.613×FLACC评分。校准曲线显示,预测概率与实际概率一致性良好(P=0.115);ROC曲线显示,该联合预测模型的曲线下面积为0.908,灵敏度80.00%,特异度93.00%,预测效能最优;DCA曲线显示,当阈值概率为18%~55%时,模型可增加临床净效益,最优阈值为30%。结论 年龄较大、漏斗胸严重及术后疼痛明显的患儿,微创矫正术后并发症发生风险更高;联合上述高危因素构建的预测模型,可早期识别高风险患儿,为临床决策提供参考依据。
- 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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备注/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