Xu Bin, Bi Jing, Fu Yong, Xu Yilong, Yu Lulu, Han Yiyuan, Lin Xiaoyan, Hong Mingyan
Department of ENT and Head and Neck Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Quanzhou Women's and Children's Hospital, China.
Int J Pediatr Otorhinolaryngol. 2025 May;192:112327. doi: 10.1016/j.ijporl.2025.112327. Epub 2025 Mar 25.
To identify risk factors for secondary post-tonsillectomy hemorrhage (SPTH) in pediatric patients undergoing Coblation procedures and develop a predictive model to support perioperative management.
A retrospective analysis was performed on 15,729 children who underwent low-temperature Coblation tonsillectomy at the Children's Hospital, Zhejiang University School of Medicine, between June 2019 and June 2024. Univariate and multivariate analysis were employed to identify factors associated with the occurrence of SPTH. A prediction model was developed based on the identified independent risk factors. To enhance the model's predictive performance and calibration, Weighted Logistic Regression was applied to construct a Nomogram model. The model was validated and evaluated using bootstrap resampling, the consistency index (C-index), Receiver Operating Characteristic (ROC) curve, and Brier Score.
Among the 15,729 patients, 9834 (62.52 %) were boys, and 5895 (37.48 %) were girls.The mean age was 6.55 ± 2.38 years, and the average length of hospitalization was 3.94 ± 1.51 days. Among the 15,729 children, 235 (1.5 %) experienced SPTH, and 42 (0.3 %) required additional general anesthesia for surgical hemostasis. Univariate analysis identified that gender, age, surgical indication, degree of tonsillar embedding, Body Mass Index (BMI), postoperative diet, and surgeon experience were significantly associated with SPTH (P < 0.05).Multivariate logistic regression analysis revealed that severe tonsillar embedding, junior surgeon, obesity, poor postoperative diet, and age ≥12 years were independent risk factors for SPTH. A Nomogram model was developed based on these independent risk factors. The model was internally validated using bootstrap resampling (1000 iterations). The results showed that the C-index was 0.817, indicating good calibration and stability; ROC curve analysis revealed an Area Under the Curve(AUC)of 0.816, demonstrating strong discriminatory ability; and the Brier Score was 0.0155, indicating minimal error between predicted probabilities and actual outcomes.
Severe tonsillar embedding, junior surgeon, obesity, poor postoperative diet, and age ≥12 years are independent risk factors for Coblation SPTH in children. The Nomogram model can quickly and efficiently calculate the bleeding rate of SPTH in children, providing valuable guidance for clinical practice.
确定接受低温等离子射频消融术的儿科患者扁桃体切除术后继发性出血（SPTH）的危险因素，并建立一个预测模型以支持围手术期管理。
对2019年6月至2024年6月在浙江大学医学院附属儿童医院接受低温等离子射频消融扁桃体切除术的15729例儿童进行回顾性分析。采用单因素和多因素分析确定与SPTH发生相关的因素。基于确定的独立危险因素建立预测模型。为提高模型的预测性能和校准度，应用加权逻辑回归构建列线图模型。使用自助重抽样、一致性指数（C指数）、受试者工作特征（ROC）曲线和Brier评分对模型进行验证和评估。
15729例患者中，男孩9834例（62.52%），女孩5895例（37.48%）。平均年龄为6.55±2.38岁，平均住院时间为3.94±1.51天。15729例儿童中，235例（1.5%）发生SPTH，42例（0.3%）需要再次全身麻醉进行手术止血。单因素分析确定性别、年龄、手术指征、扁桃体嵌顿程度、体重指数（BMI）、术后饮食和外科医生经验与SPTH显著相关（P<0.05）。多因素逻辑回归分析显示，严重扁桃体嵌顿、低年资外科医生、肥胖、术后饮食差和年龄≥12岁是SPTH的独立危险因素。基于这些独立危险因素建立了列线图模型。使用自助重抽样（1000次迭代）对模型进行内部验证。结果显示，C指数为0.817，表明校准良好且稳定性好；ROC曲线分析显示曲线下面积（AUC）为0.816，表明具有较强的区分能力；Brier评分为0.0155，表明预测概率与实际结果之间的误差最小。
严重扁桃体嵌顿、低年资外科医生、肥胖、术后饮食差和年龄≥12岁是儿童低温等离子射频消融扁桃体切除术后SPTH的独立危险因素。列线图模型可以快速有效地计算儿童SPTH的出血率，为临床实践提供有价值的指导。
