Frontiers in surgery · 2026
Development and validation of a nomogram predicting the risk of necrosis in fingertip replantation: a single-center retrospective study.
СтатьяНазвание и аннотация: Перевод в очереди
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Li Yadong, Hou Xinwei, Dong Shuai, Zhang Yan, Wang Zhongliang, Ju Jihui, Jin Guangzhe
Аннотация
BACKGROUND: Necrosis remains an important complication after fingertip replantation. We aimed to develop and internally validate a model for estimating necrosis risk using clinical, procedural, and early-postoperative information.
METHODS: We retrospectively analyzed 1,344 patients who underwent replantation of 1,497 fingertips at a single center between August 2018 and August 2023. The patient was the unit of analysis. Patients were divided by outcome-stratified random sampling (seed 2222) into a derivation cohort (n = 942; 70%) and a split-sample internal validation cohort (n = 402; 30%). Candidate predictors were reduced by 10-fold cross-validated least absolute shrinkage and selection operator regression. A multivariable logistic regression model was specified using six predictors available during the early postoperative course. Discrimination, calibration, Brier score, and decision-curve analysis were evaluated.
RESULTS: Necrosis occurred in 115 patients (12.2%) in the derivation cohort and 48 (11.9%) in the internal validation cohort. The model retained surgeon experience, platelet count (PLT), neutrophil percentage (NEU%), D-dimer, hypertension, and vascular crisis. The area under the receiver operating characteristic curve was 0.953 (95% CI, 0.935-0.968) in the derivation cohort and 0.974 (95% CI, 0.958-0.987) in the internal validation cohort. Corresponding Brier scores were 0.051 and 0.042. In the internal validation cohort, the calibration intercept was -0.338 and the calibration slope was 0.759; the Hosmer-Lemeshow test yielded P = 0.729. Decision-curve analysis suggested potential net benefit across clinically plausible threshold probabilities, but external validation is required.
CONCLUSION: This split-sample internally validated nomogram estimates necrosis risk after fingertip replantation once early-postoperative laboratory results and vascular-crisis status are available. The observed discrimination should be interpreted alongside calibration shrinkage, possible overfitting, and the absence of external validation.
METHODS: We retrospectively analyzed 1,344 patients who underwent replantation of 1,497 fingertips at a single center between August 2018 and August 2023. The patient was the unit of analysis. Patients were divided by outcome-stratified random sampling (seed 2222) into a derivation cohort (n = 942; 70%) and a split-sample internal validation cohort (n = 402; 30%). Candidate predictors were reduced by 10-fold cross-validated least absolute shrinkage and selection operator regression. A multivariable logistic regression model was specified using six predictors available during the early postoperative course. Discrimination, calibration, Brier score, and decision-curve analysis were evaluated.
RESULTS: Necrosis occurred in 115 patients (12.2%) in the derivation cohort and 48 (11.9%) in the internal validation cohort. The model retained surgeon experience, platelet count (PLT), neutrophil percentage (NEU%), D-dimer, hypertension, and vascular crisis. The area under the receiver operating characteristic curve was 0.953 (95% CI, 0.935-0.968) in the derivation cohort and 0.974 (95% CI, 0.958-0.987) in the internal validation cohort. Corresponding Brier scores were 0.051 and 0.042. In the internal validation cohort, the calibration intercept was -0.338 and the calibration slope was 0.759; the Hosmer-Lemeshow test yielded P = 0.729. Decision-curve analysis suggested potential net benefit across clinically plausible threshold probabilities, but external validation is required.
CONCLUSION: This split-sample internally validated nomogram estimates necrosis risk after fingertip replantation once early-postoperative laboratory results and vascular-crisis status are available. The observed discrimination should be interpreted alongside calibration shrinkage, possible overfitting, and the absence of external validation.