Nomogram for soiling prediction in postsurgery hirschsprung children: a retrospective study

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Informatics

Background:

• Hirschsprung disease (HSCR) is a congenital condition requiring surgical intervention.
• Postoperative soiling is a common complication following HSCR surgery, impacting patient outcomes.
• Predictive tools are needed to identify patients at higher risk for this complication.

Purpose of the Study:

• To develop and validate a nomogram for predicting the probability of postoperative soiling in patients over one year old who underwent surgery for HSCR.
• To identify significant predictive factors for postoperative soiling in this patient population.

Main Methods:

• Retrospective analysis of 601 HSCR patients (age > 1 year) who underwent surgical therapy between 2000 and 2019.
• Patients were divided into training (70%) and validation (30%) sets.
• Least Absolute Shrinkage and Selection Operator (LASSO) and multivariable logistic regression were used to identify predictive variables for nomogram construction.
• Model performance was assessed using C-index, Area Under the ROC Curve (AUC), calibration curves, and decision curve analysis.

Main Results:

• Three hundred and one patients were analyzed, with 97 experiencing postoperative soiling.
• Key predictive factors for soiling included surgical history, length of resected bowel, and specific surgical procedures.
• The nomogram demonstrated strong predictive performance with a C-index of 0.871 (training) and 0.878 (validation), and AUC of 0.896 (training) and 0.866 (validation).
• Calibration curves indicated good agreement between predicted and observed soiling probabilities.

Conclusions:

• This study presents the first validated nomogram for predicting postoperative soiling risk in HSCR patients over one year of age.
• The developed model can assist clinicians in assessing individual soiling risk, facilitating personalized management strategies.
• This tool has the potential to improve patient care and outcomes following HSCR surgery.