Work

Construction and validation of a predictive nomogram for vascular crisis risk following free flap surgery

Year: 2026

Type: article

Abstract: Introduction: This study aimed to construct and validate a predictive nomogram for estimating the risk of postoperative vascular crisis in patients undergoing free flap surgery. Methods: Clinical medical records of 568 patients who underwent free flap surgery at No. 971 Hospital of the People's Liberation Army Navy between January 2012 and August 2023 were retrospectively reviewed. Based on the admission date, the training set comprised 402 patients, and the remaining 166 patients constituted the validation set. Multivariate logistic regression was used to select the variables. R software was used to develop the vascular crisis risk prediction model, evaluate its predictive performance, and visualize the model. Subsequently, the model was internally validated using the validation set. Results: Among 568 patients, the overall incidence of vascular crisis after free flap surgery was 11.1%. A nomogram was constructed using four independent risk factors: serum albumin level, smoking, hemoglobin level, and packed red blood cell suspension transfusion. The area under the receiver operating characteristic curve (AUC) was 0.817 (95% confidence interval [CI]: 0.747-0.887) for the training set and 0.852 (95% CI: 0.774-0.929) for the validation set. The calibration curve indicated satisfactory concordance between the nomogram-estimated risk and the actual clinical incidence, with a mean absolute error of 0.019 (<0.05). Decision curve analysis confirmed the favorable clinical application value of this nomogram. Discussion: The nomogram demonstrated appreciable predictive performance for vascular crisis risk in patients undergoing free flap surgery. This tool may assist in identifying high-risk populations and facilitate appropriate clinical decision-making. Clinical trial regidstration: https://www.chictr.org.cn/, China Clinical Trials Registry ChiCTR2400087348.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1930369