Establishment and validation of a risk prediction model for scoliosis after Nuss proce-dure in children and young adults with pectus excavatum
10.19723/j.issn.1671-167X.2025.05.019
- VernacularTitle:儿童及青年漏斗胸患者Nuss术后发生脊柱侧弯的风险预测模型建立及验证
- Author:
Bowen LI
1
;
Qiang ZHANG
1
;
Yixin SUN
1
Author Information
1. 首都医科大学附属北京积水潭医院胸外科,国家骨科医学中心,北京 100035
- Publication Type:Journal Article
- Keywords:
Pectus excavatum;
Nuss surgery;
Scoliosis;
Risk factors;
Nomograms
- From:
Journal of Peking University(Health Sciences)
2025;57(5):941-946
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To identify the risk factors associated with the development of post-Nuss proce-dure scoliosis in pectus excavatum patients and to establish a relevant predictive model.Methods:A retro-spective review was conducted on pectus excavatum patients who underwent Nuss procedure in Depart-ment of Thoracic Surgery at Beijing Jishuitan Hospital between January 2018 and February 2023.We gathered the patient demographic information(including age,sex,height,weight,and body mass in-dex)and diagnostic imaging results(echocardiogram,chest CT scan,full-spine radiography,and PA/lateral chest X-rays),and measurements of Haller index,asymmetry index,sternal torsion angle(STA)index,and Cobb angle changes.The risk of post-Nuss procedure scoliosis was assessed.Cox regression analysis was performed to identify independent risk factors for scoliosis development in the pectus excava-tum patients.Based on the results of the Cox regression analysis,a risk prediction model was estab-lished,and its specific predictive performance was assessed through internal cross-validation.Results:A total of 59 pectus excavatum patients who underwent Nuss procedure were included after applying inclu-sion and exclusion criteria.The median follow-up duration was 6.84 months,and the follow-up results showed significant improvements in Haller index,STA index,and asymmetry index postoperatively.Twelve patients developed scoliosis 3 months after Nuss procedure,while 47 patients did not,the inci-dence of scoliosis was 20.3％.Cox regression analysis identified preoperative pulmonary artery hyperten-sion and preoperative asymmetry index as independent risk factors for post-Nuss procedure scoliosis.A predictive model was constructed based on single-factor Cox regression analysis results,incorporating age,height,weight,body mass index,preoperative pulmonary artery hypertension,preoperative Haller index,STA index,asymmetry index,and Cobb angle.The receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)for the overall predictive model was calculated to be 0.995.A calibration curve demonstrated good alignment between predicted values and actual values.Conclusion:Nuss procedure achieved favorable clinical outcomes.However,postoperative scoliosis emerged as a significant complication with a high incidence rate.Pulmonary artery hypertension and asymmetry index were independent predictors of post-Nuss procedure scoliosis.The predictive model developed in this study demonstrated robust performance in estimating the risk of postoperative scoliosis.
