口腔颌面缺损皮瓣修复重建手术术后出血再手术风险预测模型的构建OACSTPCD

Objective:To investigate the risk factors of bleeding and reoperation after oral and maxillofacial defect flap repair and reconstruction surgery,and to establish a Logistic regression prediction model.Methods:The data of 769 pa-tients with oral and maxillofacial defect flaps who underwent reconstruction and repair in the Department of Oral and Maxillo-facial Surgery,Sun Yat-sen Memorial Hospital from January to October 2021 were retrospectively analyzed.Among them,21 patients had postoperative bleeding and reoperation.Univariate and multivariate Logistic analysis were used to analyze the in-dependent risk factors of postoperative bleeding and reoperation,and the risk prediction model was constructed.The prediction effect of the model was tested by ROC curve,and the nomogram was constructed with variables with P<0.05 in multivariate logistic regression.Results:Multifactor logistic regression analysis showed that diabetes mellitus,defect site,surgical method including carotid artery ligation,wound effusion,and wound infection were included in the final model.Diabetes mellitus(OR=3.817,95％CI 1.193～11.239),jaw defect(OR=4.313,95％CI 1.274～13.544),wound effusion(OR=9.149,95％CI 2.998～26.911)and wound infection(OR=5.940,95％CI 1.624～19.220)were independent predictors of reoperation for postoperative bleeding(P<0.05).The area under the ROC curve of this model was 0.900(95％CI 0.832,0.968),the sensi-tivity was 76.2％,the specificity was 91.2％,and the nomogram C index was 0.896(95％CI 0.829～0.964),the clinical de-cision curve results showed a risk range of 0.03～0.21.Conclusion:The model constructed in this study has a good predic-tion effect,which can provide a reference for medical staff of oral and maxillofacial head and neck surgery,guide the clinical implementation of timely and effective intervention measures,and provide a basis for the prevention of bleeding reoperation.