Construction and validation of a predictive nomogram for vascular crisis risk following free flap surgery
6 affiliations
- 1Faculty of Anesthesiology, Changhai Hospital, Naval Medical University , ,
- 2Department of Nursing, No. 971 Hospital of the People’s Liberation Army Navy , , ,
- 3Department of Hand Surgery Anesthesiology, No. 971 Hospital of the People’s Liberation Army Navy , , ,
- 4Department of Nephrology, No. 971 Hospital of the People’s Liberation Army Navy , , ,
- 5Department of Anesthesiology, Qingdao University Affiliated Hospital , , ,
- 6Department of Anesthesiology, Naval Medical Center, Naval Medical University , ,
Abstract
Introduction: This study aimed to construct and validate a predictive nomogram for estimating the risk of postoperative vascular crisis in patients undergoing free flap surgery.
Methods: Clinical medical records of 568 patients who underwent free flap surgery at No. 971 Hospital of the People's Liberation Army Navy between January 2012 and August 2023 were retrospectively reviewed. Based on the admission date, the training set comprised 402 patients, and the remaining 166 patients constituted the validation set. Multivariate logistic regression was used to select the variables. R software was used to develop the vascular crisis risk prediction model, evaluate its predictive performance, and visualize the model. Subsequently, the model was internally validated using the validation set.
Results: Among 568 patients, the overall incidence of vascular crisis after free flap surgery was 11.1%. A nomogram was constructed using four independent risk factors: serum albumin level, smoking, hemoglobin level, and packed red blood cell suspension transfusion. The area under the receiver operating characteristic curve (AUC) was 0.817 (95% confidence interval [CI]: 0.747–0.887) for the training set and 0.852 (95% CI: 0.774–0.929) for the validation set. The calibration curve indicated satisfactory concordance between the nomogram-estimated risk and the actual clinical incidence, with a mean absolute error of 0.019 (<0.05). Decision curve analysis confirmed the favorable clinical application value of this nomogram.
Discussion: The nomogram demonstrated appreciable predictive performance for vascular crisis risk in patients undergoing free flap surgery. This tool may assist in identifying high-risk populations and facilitate appropriate clinical decision-making.
Clinical trial regidstration: https://www.chictr.org.cn/, China Clinical Trials Registry ChiCTR2400087348
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BibTeX
@article{qu2026construction,
title = {{Construction and validation of a predictive nomogram for vascular crisis risk following free flap surgery}},
author = {Yan-liang Qu and Juan Xue and Xing-yu Du and Dai-di Zhang and Yue Wang and Ya-lin Zhu and Jia-feng Wang},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1930369},
url = {https://europepmc.org/article/PMC/PMC13727465},
note = {CC BY},
}
RIS
TY - JOUR
TI - Construction and validation of a predictive nomogram for vascular crisis risk following free flap surgery
AU - Yan-liang Qu
AU - Juan Xue
AU - Xing-yu Du
AU - Dai-di Zhang
AU - Yue Wang
AU - Ya-lin Zhu
AU - Jia-feng Wang
PY - 2026
DA - 2026/10/20
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1930369
UR - https://europepmc.org/article/PMC/PMC13727465
AB - Introduction: This study aimed to construct and validate a predictive nomogram for estimating the risk of postoperative vascular crisis in patients undergoing free flap surgery. Methods: Clinical medical records of 568 patients who underwent free flap surgery at No. 971 Hospital of the People's Liberation Army Navy between January 2012 and August 2023 were retrospectively reviewed. Based on the admission date, the training set comprised 402 patients, and the remaining 166 patients constituted the validation set. Multivariate logistic regression was used to select the variables. R software was used to develop the vascular crisis risk prediction model, evaluate its predictive performance, and visualize the model. Subsequently, the model was internally validated using the validation set. Results: Among 568 patients, the overall incidence of vascular crisis after free flap surgery was 11.1%. A nomogram was constructed using four independent risk factors: serum albumin level, smoking, hemoglobin level, and packed red blood cell suspension transfusion. The area under the receiver operating characteristic curve (AUC) was 0.817 (95% confidence interval [CI]: 0.747–0.887) for the training set and 0.852 (95% CI: 0.774–0.929) for the validation set. The calibration curve indicated satisfactory concordance between the nomogram-estimated risk and the actual clinical incidence, with a mean absolute error of 0.019 (<0.05). Decision curve analysis confirmed the favorable clinical application value of this nomogram. Discussion: The nomogram demonstrated appreciable predictive performance for vascular crisis risk in patients undergoing free flap surgery. This tool may assist in identifying high-risk populations and facilitate appropriate clinical decision-making. Clinical trial regidstration: https://www.chictr.org.cn/, China Clinical Trials Registry ChiCTR2400087348
SN - 2296-858X
ER -