Abstract
BACKGROUND: Since the respiratory anatomy and physiology of children differ from those of adults, they are more susceptible to postoperative pulmonary complications after thoracic surgery that requires one-lung ventilation. Hypothesizing that the incidence of postoperative pulmonary complications could be predicted using easily accessible perioperative variables, we aimed to develop a nomogram specifically for children receiving thoracic surgery with one-lung ventilation. METHODS: A total of 361 children undergoing thoracic surgery with one-lung ventilation were randomly assigned to two groups: a training cohort (80%) and a validation cohort (20%). The training cohort was utilized to develop a nomogram, whereas the validation cohort was used to assess its performance. The outcome of this study was the incidence of postoperative pulmonary complications. Univariate analysis and the least absolute shrinkage and selection operator regression model were applied to select the most relevant prognostic predictors. Multivariable logistic regression was used to develop a nomogram based on the selected prediction factors. Internal validation was conducted to evaluate its performance. The C-index and calibration plots were used to assess its discriminative ability and calibration. RESULTS: Among the included patients, 109 (30.2%) presented postoperative pulmonary complications. Four predictive factors were ultimately selected to develop the nomogram. They were preoperative neutrophil-to-lymphocyte ratio, intraoperative ventilation mode, maximum peak airway pressure and minimum oxygenation index during one-lung ventilation. By incorporating these factors, the nomogram demonstrated strong C-indices of 0.909 (95% confidence interval (CI) [0.809-0.82]) and 0.871 (95% CI [0.795-0.945]) in the training and validation cohorts, respectively, along with well-matched calibration curves. CONCLUSION: The nomogram, based on four objective and easily assessed factors, demonstrates excellent predictive performance for pediatric postoperative pulmonary complications after one-lung ventilation, enabling early risk assessment and targeted interventions to improve patient outcomes. TRIAL REGISTRATION: This study is registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR2300072042, Date of Registration: 1/6/2023).