Risk factors for pressure alopecia after pyeloplasty in children

To explore the risk factors for pressure alopecia (PA) after pyeloplasty in children and propose preventive measures.

A retrospective analysis was conducted on pediatric patients with hydronephrosis who underwent minimally invasive pyeloplasty (laparoscopic or robot-assisted laparoscopic) between October 2018 and October 2020. General demographics, head compression duration, intraoperative head positioning management and scalp protective measures were compared between patients with and without postoperative PA. Variables with significant differences in univariate analysis were included in multivariate Logistic regression. The receiver operating characteristic (ROC) curve was used to assess the predictive value of head compression duration for PA.

A total of 288 children were enrolled, among whom 22 (7.64%) developed postoperative PA. Multivariate Logistic regression revealed that lack of intraoperative head repositioning (OR = 6.00, 95% CI: 1.91-23.96, P = 0.005) and prolonged head compression duration (OR = 2.90, 95% CI: 1.81-4.79, P < 0.001) were independent risk factors for PA. ROC analysis showed the area under the curve (AUC) was 0.823 (95% CI: 0.731-0.915). The optimal cut-off value of head compression duration was 3.5 h, with a sensitivity of 86.8% and a specificity of 72.7%.

Absence of regular intraoperative head repositioning and prolonged head compression duration are independent risk factors for PA after pediatric pyeloplasty. A head compression duration longer than 3.5 h markedly increases PA risk. Intraoperative position management should be strengthened and targeted protective measures should be implemented.