Development and internal validation of a perioperative nomogram for predicting moderate-to-severe acute postoperative pain after hepatectomy for hepatocellular carcinoma.
4 affiliations
- 1Department of General Surgery (Vascular Ward), The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, 221000, China.
- 2Oncology Department, Donghai County People's Hospital, Lianyungang, Jiangsu Province, 222300, China.
- 3Department of General Surgery (Vascular Ward), The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, 221000, China. [email protected].
- 4, No.9 Kunpeng Road, Xuzhou, Jiangsu Province, 221000, China. [email protected].
Abstract
Background
Moderate-to-severe acute postoperative pain (APOP) after hepatectomy for hepatocellular carcinoma (HCC) may impede early postoperative recovery. However, predictive tools integrating preoperative and intraoperative risk factors are lacking. This study aimed to develop and internally validate a perioperative nomogram for predicting APOP in this population.Methods
Adult patients who underwent elective hepatectomy for primary HCC between January 2021 and January 2025 were retrospectively enrolled and randomly divided into a training cohort (n = 301) and a holdout internal validation cohort (n = 129). Moderate-to-severe APOP was defined as a maximum prerescue NRS score ≥ 4 during repeated pain assessments within 72 h after surgery. Candidate predictors included demographic, tumor-related, laboratory, psychological, and intraoperative variables. Multiple imputation was used to address missing data, and LASSO followed by multivariable logistic regression was used to select predictors and construct the perioperative nomogram. Model performance was assessed using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA).Results
Moderate-severe APOP occurred in 42.1% of patients. Seven predictors were included: younger age, an actual open surgical approach, a larger maximal tumor diameter, a higher neutrophil-to-lymphocyte ratio, greater intraoperative opioid consumption, and higher preoperative Hospital Anxiety and Depression Scale and Pain Catastrophizing Scale scores. The nomogram showed good discrimination in the training cohort (AUC = 0.818; 95% CI: 0.771-0.865) and the holdout internal validation cohort (AUC = 0.795; 95% CI: 0.720-0.870), with satisfactory calibration and positive net clinical benefit in terms of DCA.Conclusion
A perioperative nomogram integrating preoperative and intraoperative variables was developed and internally validated. Because the complete predictor set becomes available only at the end of surgery, the model is intended to support immediate postoperative risk stratification and individualized analgesic and psychological interventions after hepatectomy for patients with HCC.
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BibTeX
@article{wang2026development,
title = {{Development and internal validation of a perioperative nomogram for predicting moderate-to-severe acute postoperative pain after hepatectomy for hepatocellular carcinoma.}},
author = {Juan Wang and Chunmei Fan and Wanqiu Zhang and Yan Zhang and Ting Li},
journal = {BMC surgery},
year = {2026},
month = aug,
doi = {10.1186/s12893-026-04075-9},
url = {https://europepmc.org/article/MED/42958184},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Development and internal validation of a perioperative nomogram for predicting moderate-to-severe acute postoperative pain after hepatectomy for hepatocellular carcinoma.
AU - Juan Wang
AU - Chunmei Fan
AU - Wanqiu Zhang
AU - Yan Zhang
AU - Ting Li
PY - 2026
DA - 2026/08/03
JO - BMC surgery
DO - 10.1186/s12893-026-04075-9
UR - https://europepmc.org/article/MED/42958184
AB - Background Moderate-to-severe acute postoperative pain (APOP) after hepatectomy for hepatocellular carcinoma (HCC) may impede early postoperative recovery. However, predictive tools integrating preoperative and intraoperative risk factors are lacking. This study aimed to develop and internally validate a perioperative nomogram for predicting APOP in this population.Methods Adult patients who underwent elective hepatectomy for primary HCC between January 2021 and January 2025 were retrospectively enrolled and randomly divided into a training cohort (n = 301) and a holdout internal validation cohort (n = 129). Moderate-to-severe APOP was defined as a maximum prerescue NRS score ≥ 4 during repeated pain assessments within 72 h after surgery. Candidate predictors included demographic, tumor-related, laboratory, psychological, and intraoperative variables. Multiple imputation was used to address missing data, and LASSO followed by multivariable logistic regression was used to select predictors and construct the perioperative nomogram. Model performance was assessed using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA).Results Moderate-severe APOP occurred in 42.1% of patients. Seven predictors were included: younger age, an actual open surgical approach, a larger maximal tumor diameter, a higher neutrophil-to-lymphocyte ratio, greater intraoperative opioid consumption, and higher preoperative Hospital Anxiety and Depression Scale and Pain Catastrophizing Scale scores. The nomogram showed good discrimination in the training cohort (AUC = 0.818; 95% CI: 0.771-0.865) and the holdout internal validation cohort (AUC = 0.795; 95% CI: 0.720-0.870), with satisfactory calibration and positive net clinical benefit in terms of DCA.Conclusion A perioperative nomogram integrating preoperative and intraoperative variables was developed and internally validated. Because the complete predictor set becomes available only at the end of surgery, the model is intended to support immediate postoperative risk stratification and individualized analgesic and psychological interventions after hepatectomy for patients with HCC.
SN - 1471-2482
ER -