A nomogram for predicting emergence agitation after laparoscopic high ligation of the hernia sac in children

Emergence agitation (EA) is a frequent recovery complication in children and may compromise postoperative safety. This study aimed to develop and internally validate an exploratory model for predicting Pediatric Anesthesia Emergence Delirium (PAED)-defined EA after laparoscopic high ligation of the hernia sac.

This single-center retrospective prediction-model study screened 342 consecutive procedures performed from January 2022 to December 2024. Complete-case analysis included 287 children. The prediction time was immediately before planned tracheal extubation and before the first PAED assessment. After review of the original data-driven selection results, a post hoc four-predictor logistic model was constructed using age, baseline preoperative anxiety, sedative premedication, and intraoperative regional block. Conditional internal validation was performed using 1,000 bootstrap resamples.

PAED-defined EA occurred in 93 children (32.4%). Increasing age was associated with lower odds of EA, whereas baseline preoperative anxiety was associated with higher odds; sedative premedication and intraoperative regional block were associated with lower odds. The model showed an apparent area under the receiver operating characteristic curve of 0.768 (95% confidence interval, 0.710-0.826) and an optimism-corrected value of 0.755. The optimism-corrected calibration slope and intercept were 0.943 and -0.028, respectively, and the corrected Brier score was 0.185.

The post hoc four-predictor nomogram showed moderate discrimination and acceptable internal calibration for estimating PAED-defined EA risk. Independent external validation and prospective clinical impact assessment are required before implementation.