Abstract / Summary
Abstract Background Currently, early and simple tools for assessing the risk of in-hospital sternal wound complications (SWC) following aortic dissection surgery remain lacking. This study aimed to develop and internally validate a prediction model based on early postoperative objective indicators. Methods Between January 2020 and December 2023, we consecutively enrolled patients with Stanford type A aortic dissection who met the inclusion criteria and underwent surgical treatment at our institution, following predefined exclusion criteria. A total of 243 patients were finally included, of whom 58 (23.9%) developed in-hospital SWC. Variables with P < 0.1 in univariate analysis were screened for collinearity and clinical relevance before entry into a multivariable logistic regression model using the Enter method. A nomogram was constructed based on the multivariable analysis results. The model‘s performance was evaluated via bootstrap internal validation (1000 resamples) in terms of discrimination (AUC), calibration, and clinical utility (DCA). A simplified scoring system was derived as an exploratory analysis. Results Multivariable logistic regression identified three independent predictors of in-hospital SWC: rewarming time (OR = 0.983 per minute, 95% CI: 0.970–0.996, P = 0.012), postoperative day 2 drainage output (OR = 1.22 per 100 mL, 95% CI: 1.10–1.35, P = 0.002), and postoperative day 1 hemoglobin (OR = 0.976 per g/L, 95% CI: 0.954–0.998, P = 0.035), all three of which were incorporated into the final nomogram. The constructed nomogram demonstrated moderate discriminative ability (AUC = 0.702, 95% CI: 0.630–0.775) and good calibration (calibration intercept = -0.115, slope = 0.888, Brier score = 0.170). The simplified scoring system showed an AUC of 0.699 (95% CI: 0.635–0.763). When patients were stratified into low- (0 points), intermediate- (1–2 points), and high-risk (3 points) groups, the event rates were 6.7%, 21.7%, and 38.6%, respectively, showing a significant increasing trend (P for trend = 0.004). Conclusion This study identified rewarming time, postoperative day 2 drainage output, and postoperative day 1 hemoglobin as independent predictors of in-hospital SWC after aortic dissection. The nomogram incorporating these three variables demonstrated moderate discriminative ability and good calibration upon internal validation, supporting its potential utility as an internally validated exploratory model for early risk stratification. The simplified scoring system derived from the model showed modest performance as an exploratory tool and requires prospective external validation before clinical application.