Prediction of swallowing improvement after tracheal reconstruction in patients receiving LFES-containing rehabilitation: a retrospective cohort study.
- 1Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Abstract
Background
Dysphagia is a clinically important complication after tracheal reconstruction. Low-frequency electrical stimulation (LFES) supports postoperative swallowing rehabilitation, yet swallowing outcomes vary substantially among patients. We aimed to identify prognostic factors associated with observed swallowing improvement and to develop an internally validated clinical prediction model among patients receiving LFES-containing rehabilitation after tracheal reconstruction.Methods
This retrospective cohort study included 200 patients with postoperative dysphagia who received LFES-containing rehabilitation. Patients were grouped by prespecified criteria for swallowing improvement after rehabilitation. Demographic, perioperative, swallowing-related, and prespecified treatment-plan variables available before rehabilitation were evaluated. The cohort was divided by outcome-stratified random sampling into training and independent validation sets. Candidate predictors were examined using univariable logistic regression, LASSO, random forest, and XGBoost, followed by multivariable logistic regression. Model performance was assessed using ROC analysis, calibration, bootstrap internal validation, and exploratory decision-curve, subgroup, and sensitivity analyses.Results
Among 200 patients, 126 (63.0%) met the prespecified swallowing-improvement criteria. Older age (OR = 0.96, 95% CI: 0.93-0.98) and aspiration (OR = 0.41, 95% CI: 0.18-0.88) were independently associated with a lower probability of improvement, whereas a greater planned number of LFES sessions was associated with a higher probability of improvement (OR = 1.09, 95% CI: 1.04-1.16). The logistic regression model achieved AUCs of 0.776 in the training set and 0.767 in the independent validation set, with acceptable calibration. The optimism-corrected AUC after 500 bootstrap resamples was 0.721. Exploratory decision-curve analysis suggested potential net benefit across portions of the evaluated threshold-probability range. XGBoost achieved the numerically highest validation AUC (0.780), followed by logistic regression (0.765) and random forest (0.760), with only small absolute differences among these models. Main associations were generally consistent across sensitivity analyses.Conclusion
Among patients receiving LFES-containing rehabilitation after tracheal reconstruction, older age and aspiration were associated with a lower probability of observed swallowing improvement, whereas a greater planned number of LFES sessions was associated with a higher probability of improvement. The model demonstrated moderate discrimination and may provide a preliminary framework for prognostic risk stratification and identifying patients who warrant closer rehabilitation monitoring. External validation is required before routine clinical use.
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BibTeX
@article{liang2026prediction,
title = {{Prediction of swallowing improvement after tracheal reconstruction in patients receiving LFES-containing rehabilitation: a retrospective cohort study.}},
author = {Yunjuan Liang and Jinfen Hu and Yuying Liang and Xiaoying Xia},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1909631},
url = {https://europepmc.org/article/MED/42909044},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prediction of swallowing improvement after tracheal reconstruction in patients receiving LFES-containing rehabilitation: a retrospective cohort study.
AU - Yunjuan Liang
AU - Jinfen Hu
AU - Yuying Liang
AU - Xiaoying Xia
PY - 2026
DA - 2026/10/07
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1909631
UR - https://europepmc.org/article/MED/42909044
AB - Background Dysphagia is a clinically important complication after tracheal reconstruction. Low-frequency electrical stimulation (LFES) supports postoperative swallowing rehabilitation, yet swallowing outcomes vary substantially among patients. We aimed to identify prognostic factors associated with observed swallowing improvement and to develop an internally validated clinical prediction model among patients receiving LFES-containing rehabilitation after tracheal reconstruction.Methods This retrospective cohort study included 200 patients with postoperative dysphagia who received LFES-containing rehabilitation. Patients were grouped by prespecified criteria for swallowing improvement after rehabilitation. Demographic, perioperative, swallowing-related, and prespecified treatment-plan variables available before rehabilitation were evaluated. The cohort was divided by outcome-stratified random sampling into training and independent validation sets. Candidate predictors were examined using univariable logistic regression, LASSO, random forest, and XGBoost, followed by multivariable logistic regression. Model performance was assessed using ROC analysis, calibration, bootstrap internal validation, and exploratory decision-curve, subgroup, and sensitivity analyses.Results Among 200 patients, 126 (63.0%) met the prespecified swallowing-improvement criteria. Older age (OR = 0.96, 95% CI: 0.93-0.98) and aspiration (OR = 0.41, 95% CI: 0.18-0.88) were independently associated with a lower probability of improvement, whereas a greater planned number of LFES sessions was associated with a higher probability of improvement (OR = 1.09, 95% CI: 1.04-1.16). The logistic regression model achieved AUCs of 0.776 in the training set and 0.767 in the independent validation set, with acceptable calibration. The optimism-corrected AUC after 500 bootstrap resamples was 0.721. Exploratory decision-curve analysis suggested potential net benefit across portions of the evaluated threshold-probability range. XGBoost achieved the numerically highest validation AUC (0.780), followed by logistic regression (0.765) and random forest (0.760), with only small absolute differences among these models. Main associations were generally consistent across sensitivity analyses.Conclusion Among patients receiving LFES-containing rehabilitation after tracheal reconstruction, older age and aspiration were associated with a lower probability of observed swallowing improvement, whereas a greater planned number of LFES sessions was associated with a higher probability of improvement. The model demonstrated moderate discrimination and may provide a preliminary framework for prognostic risk stratification and identifying patients who warrant closer rehabilitation monitoring. External validation is required before routine clinical use.
SN - 2296-875X
ER -