Frontiers in endocrinology · 2025
Preoperative assessment for the risk of Clavien-Dindo classification ≥ II grade complications after total parathyroidectomy without auto-transplantation in patients with secondary hyperparathyroidism.
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Ni Yuanzhi, Xu Lindi, Li Zhenli, Li Liang, Yan Shihang, Cheng Guangming, Wang Chunhui, Tang Yufu
Аннотация
OBJECTIVE: Complications following total parathyroidectomy (TPTX) without autotransplantation adversely affect the prognosis of patients with secondary hyperparathyroidism (SHPT). This study aimed to identify preoperative risk factors of Clavien-Dindo grade ≥ II complications after TPTX in SHPT patients, and develop a visualized model to predict the risk of complications (≥ grade II).
METHODS: Clinical data were retrospectively collected from SHPT patients who underwent TPTX at our center between January 2013 and March 2025. The cohort was chronologically divided into a training set (n=552) and a validation set (n=236) in a 7:3 ratio. Postoperative complication severity was assessed using the Clavien-Dindo classification system. Patients were stratified into two groups based on complication grade: a high-risk group (grade ≥II) and a low-risk group (grade <II or no complications). Independent risk factors of Clavien-Dindo grade ≥ II complications were identified through univariate and multivariate logistic regression analyses. A nomogram was developed using these independent risk factors. The performance of this model was then evaluated using the validation set.
RESULTS: Among 788 patients, 546 (69.3%) developed postoperative complications, including 369 cases (46.8%) of grade ≥ II complications. Multivariate analysis identified serum alkaline phosphatase, intact parathyroid hormone, serum calcium, and serum potassium as independent risk factors of grade ≥II complications. The nomogram achieved good concordance indexes of 0.826 (95% confidence interval (CI), 0.778-0.874) and 0.807 (95% confidence interval (CI), 0.739-0.874) in predicting the risk of postoperative complications (grade ≥ II) in the training and validation cohorts, respectively, with well-fitted calibration curves. Both the decision curve and the clinical impact curve indicated substantial clinical benefit provided by the nomogram.
CONCLUSION: A nomogram was developed and validated to predict complications (grade ≥ II) following TPTX without autotransplantation in patients with SHPT. This model may aid in identifying high-risk patients and informing perioperative decision-making.
METHODS: Clinical data were retrospectively collected from SHPT patients who underwent TPTX at our center between January 2013 and March 2025. The cohort was chronologically divided into a training set (n=552) and a validation set (n=236) in a 7:3 ratio. Postoperative complication severity was assessed using the Clavien-Dindo classification system. Patients were stratified into two groups based on complication grade: a high-risk group (grade ≥II) and a low-risk group (grade <II or no complications). Independent risk factors of Clavien-Dindo grade ≥ II complications were identified through univariate and multivariate logistic regression analyses. A nomogram was developed using these independent risk factors. The performance of this model was then evaluated using the validation set.
RESULTS: Among 788 patients, 546 (69.3%) developed postoperative complications, including 369 cases (46.8%) of grade ≥ II complications. Multivariate analysis identified serum alkaline phosphatase, intact parathyroid hormone, serum calcium, and serum potassium as independent risk factors of grade ≥II complications. The nomogram achieved good concordance indexes of 0.826 (95% confidence interval (CI), 0.778-0.874) and 0.807 (95% confidence interval (CI), 0.739-0.874) in predicting the risk of postoperative complications (grade ≥ II) in the training and validation cohorts, respectively, with well-fitted calibration curves. Both the decision curve and the clinical impact curve indicated substantial clinical benefit provided by the nomogram.
CONCLUSION: A nomogram was developed and validated to predict complications (grade ≥ II) following TPTX without autotransplantation in patients with SHPT. This model may aid in identifying high-risk patients and informing perioperative decision-making.