Development of a nomogram to predict negative postoperative behavioral changes based on a prospective cohort

Area of Science:

• Pediatric Anesthesiology
• Behavioral Science
• Clinical Prediction Modeling

Background:

• Negative postoperative behavioral changes (NPOBC) in children are linked to adverse perioperative outcomes.
• Predicting NPOBC is crucial for improving pediatric surgical care.
• A predictive model for NPOBC is needed.

Purpose of the Study:

• Identify risk factors for NPOBC in children.
• Develop a nomogram to predict NPOBC on postoperative day 3.
• Validate the predictive accuracy of the nomogram.

Main Methods:

• Prospective observational study of 192 children (2-12 years) undergoing general anesthesia.
• Assessed NPOBC using the Posthospital Behaviour Questionnaire (PHBQ).
• Used logistic regression to identify risk factors and develop a nomogram, validated internally.

Main Results:

• 44.8% of children developed NPOBC on postoperative day 3.
• Independent predictors for NPOBC included Pediatric Anesthesia Behavior (PAB) score, cerebral desaturation, and postoperative pain score.
• The developed nomogram showed good discrimination (AUC: 0.762) and clinical utility.

Conclusions:

• Higher PAB scores, cerebral desaturation, and postoperative pain predict NPOBC in children.
• A validated nomogram can aid in individual patient assessment and risk stratification.
• The nomogram can help identify high-risk groups and improve patient prognosis.