Predicting drooling severity after surgery in youth with neurodevelopmental disabilities: development of a proof-of-principle multivariable prognostic model
6 affiliations
- 1Radboud University Medical Center, Department of Otorhinolaryngology, Nijmegen, the Netherlands; Corresponding author at: Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
- 2Radboud University Medical Center, Department of IQ Health, Nijmegen, the Netherlands
- 3Radboud University Medical Center, Department of Rehabilitation, Amalia Children's Hospital, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands
- 4Radboud University Medical Center, Department of Pediatric Neurology, Amalia Children's Hospital, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
- 5Radboud University Medical Center, Department of Otorhinolaryngology, Nijmegen, the Netherlands
- 6Radboud University Medical Center, Department of Otorhinolaryngology, Nijmegen, the Netherlands; Gelderse Vallei Hospital, Department of Otolaryngology, Ede, the Netherlands
Abstract
Introduction: Predicting outcomes of surgery for drooling could support candidate selection and shape expectations for patients and caregivers. This study describes the development of a prognostic prediction model for the expected drooling Visual Analog Scale (VAS) at 32-weeks post-surgery in youth with a neurodevelopmental disability. Methods: A multivariable linear model was developed with data from a prospectively gathered pseudonymized database of drooling patients from the Saliva Control Clinic of a Dutch tertiary care center. The population consisted of drooling patients with a non-progressive neurodevelopmental disability who underwent surgery for drooling between January 2000 and March 2023. The outcome measure for the model was the VAS at 32-week follow-up. The baseline VAS was incorporated in the model to take into account the relative change compared to baseline. Internal validation was performed using bootstrapping. Results: The model was developed based on 227 patients (37.4% female, median age at surgery = 14.0). The final parsimonious model included 15 variables, resulting in an apparent pooled R 2 = 0.26 and an R 2 -adjusted= 0.21. Internal validation resulted in a calibration slope of 0.86 with an optimism-corrected R 2 of 0.16. Several parameters contributed significantly to predicting the outcome after surgery. These included age, VAS at baseline, type of surgery, type of neurodevelopmental disability, ambulatory status, use of laxatives or prokinetic agents, severe dysphagia, and abnormal oral suction and propulsion capacity. Discussion: This study provides a proof of principle that a multivariable linear prediction model can estimate postoperative anterior drooling severity in youth with neurodevelopmental disabilities undergoing surgery, using routinely available clinical characteristics. The model has not undergone external validation and is therefore not intended for clinical use in its current form. Rather, these findings demonstrate the potential of individualized outcome prediction in this population and support multicenter collaboration for external validation and further refinement. If validated, such a model could eventually support clinicians and caregivers in setting realistic expectations and assessing whether the anticipated benefit of an already selected surgical procedure is sufficient to proceed with surgery.
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BibTeX
@article{nieuwenhof2026predicting,
title = {{Predicting drooling severity after surgery in youth with neurodevelopmental disabilities: development of a proof-of-principle multivariable prognostic model}},
author = {Daan W.A. van den Nieuwenhof and Rogier Donders and Karen van Hulst and Lynn B. Orriëns and Corrie E. Erasmus and Frank J.A. van den Hoogen and Stijn Bekkers},
journal = {American Journal of Otolaryngology},
year = {2026},
month = oct,
doi = {10.1016/j.amjoto.2026.104965},
url = {https://doi.org/10.1016/j.amjoto.2026.104965},
note = {CC BY},
}
RIS
TY - JOUR
TI - Predicting drooling severity after surgery in youth with neurodevelopmental disabilities: development of a proof-of-principle multivariable prognostic model
AU - Daan W.A. van den Nieuwenhof
AU - Rogier Donders
AU - Karen van Hulst
AU - Lynn B. Orriëns
AU - Corrie E. Erasmus
AU - Frank J.A. van den Hoogen
AU - Stijn Bekkers
PY - 2026
DA - 2026/10/30
JO - American Journal of Otolaryngology
DO - 10.1016/j.amjoto.2026.104965
UR - https://doi.org/10.1016/j.amjoto.2026.104965
AB - Introduction: Predicting outcomes of surgery for drooling could support candidate selection and shape expectations for patients and caregivers. This study describes the development of a prognostic prediction model for the expected drooling Visual Analog Scale (VAS) at 32-weeks post-surgery in youth with a neurodevelopmental disability. Methods: A multivariable linear model was developed with data from a prospectively gathered pseudonymized database of drooling patients from the Saliva Control Clinic of a Dutch tertiary care center. The population consisted of drooling patients with a non-progressive neurodevelopmental disability who underwent surgery for drooling between January 2000 and March 2023. The outcome measure for the model was the VAS at 32-week follow-up. The baseline VAS was incorporated in the model to take into account the relative change compared to baseline. Internal validation was performed using bootstrapping. Results: The model was developed based on 227 patients (37.4% female, median age at surgery = 14.0). The final parsimonious model included 15 variables, resulting in an apparent pooled R 2 = 0.26 and an R 2 -adjusted= 0.21. Internal validation resulted in a calibration slope of 0.86 with an optimism-corrected R 2 of 0.16. Several parameters contributed significantly to predicting the outcome after surgery. These included age, VAS at baseline, type of surgery, type of neurodevelopmental disability, ambulatory status, use of laxatives or prokinetic agents, severe dysphagia, and abnormal oral suction and propulsion capacity. Discussion: This study provides a proof of principle that a multivariable linear prediction model can estimate postoperative anterior drooling severity in youth with neurodevelopmental disabilities undergoing surgery, using routinely available clinical characteristics. The model has not undergone external validation and is therefore not intended for clinical use in its current form. Rather, these findings demonstrate the potential of individualized outcome prediction in this population and support multicenter collaboration for external validation and further refinement. If validated, such a model could eventually support clinicians and caregivers in setting realistic expectations and assessing whether the anticipated benefit of an already selected surgical procedure is sufficient to proceed with surgery.
SN - 1532-818X
SN - 0196-0709
ER -