Development and internal validation of a nomogram for predicting high-risk postoperative status after thoracoscopic pulmonary wedge resection: a single-center retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Routine placement of a chest tube after thoracoscopic pulmonary wedge resection may cause postoperative pain and delay recovery, yet safe implementation requires accurate identification of patients at low risk for significant drainage, air leak, and pneumothorax. This study aimed to identify independent risk factors for failure to meet early chest tube removal criteria after video-assisted thoracoscopic surgery (VATS) pulmonary wedge resection, and to establish a validated nomogram for individualized risk stratification to inform postoperative chest tube management decisions. Methods: This retrospective single-center study included 680 patients who underwent VATS wedge resection between January 2023 and December 2025. Low-risk status was defined as chest tube drainage ≤200 mL within 24 hours, absence of air leak on coughing, and no significant pneumothorax on chest radiography. The cohort was randomly divided into a training set (70%) and an internal validation set (30%). Univariate and multivariate logistic regression were used to identify independent predictors of high-risk status. A nomogram was developed and internally validated using bootstrap resampling (500 replicates). Model performance was assessed by discrimination (area under the receiver operating characteristic curve, AUC), calibration, and decision curve analysis (DCA). Results: Six independent predictors were identified: age [odds ratio (OR) =1.042, 95% confidence interval (CI): 1.019-1.066, P<0.001], lower forced expiratory volume in 1 second percentage (FEV1%) predicted (OR =0.907, 95% CI: 0.883-0.928, P<0.001), neoadjuvant chemotherapy (OR =2.794, 95% CI: 1.244-6.340, P=0.013), operative duration (OR =1.033, 95% CI: 1.018-1.049, P<0.001), number of stapler cartridges used (OR =1.173, 95% CI: 1.106-1.258, P=0.041), and pleural adhesion degree (OR =3.649, 95% CI: 1.340-13.351, P=0.023). The nomogram showed good discrimination (training AUC =0.865; validation AUC =0.835) and excellent calibration (bootstrap-corrected calibration curve; Hosmer-Lemeshow P=0.62). DCA confirmed its clinical utility across threshold probabilities of 10-40%. No significant difference was observed between training and validation AUCs (ΔAUC =0.030, P=0.433). Conclusions: A six-variable nomogram incorporating age, FEV1% predicted, neoadjuvant chemotherapy, operative duration, number of stapler cartridges used, and pleural adhesion degree was developed to predict failure to meet early chest tube removal criteria after VATS wedge resection. This tool may assist in individualized risk stratification to inform clinical decision-making regarding chest tube management.
Source: Journal of Thoracic Disease
Institutions: Shanghai Jiao Tong University, Shanghai Chest Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224079990