Risk factors for postoperative recurrence of chronic subdural hematoma and construction and validation of an online dynamic nomogram prediction model.
- 1Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Abstract
Objective
To investigate factors associated with postoperative recurrence in patients with chronic subdural hematoma (CSDH) and to construct and internally validate an online dynamic nomogram for individualized recurrence-risk estimation.Methods
This retrospective single-center study included 284 surgically treated patients with CSDH between January 2018 and May 2025. Before model development, the cohort was divided at a 7:3 ratio into a training cohort (n = 198) and a validation cohort (n = 86). Univariate analysis, multivariable logistic regression, predictor selection, and nomogram construction were performed exclusively in the training cohort, whereas the validation cohort was reserved for model performance assessment. Recurrence was defined as reaccumulation or enlargement of the hematoma on postoperative CT within 6 months after surgery, accompanied by recurrent or worsening neurological symptoms, regardless of whether repeat surgery was subsequently performed.Results
Overall, 54 of 284 patients (19.01%) experienced recurrence; 33 recurrence events occurred in the training cohort and 21 in the validation cohort. Smoking history, laterality, hematoma density, greatest hematoma thickness, cerebral midline shift ≥10 mm, and postoperative pneumocephalus were statistically significant in the multivariable analysis. The AUC was 0.89 (95% CI, 0.82-0.95, sensitivity 0.82, specificity 0.85) in the training cohort and 0.74 (95% CI, 0.59-0.88, sensitivity 0.52, specificity 0.85) in the validation cohort. Bootstrap optimism correction yielded an apparent AUC of 0.892, a mean optimism of 0.021, and an optimism-corrected AUC of 0.871. In the training cohort, the Hosmer-Lemeshow test showed no statistically significant evidence of lack of fit (χ ² = 9.96, df = 8, p = 0.268).Conclusion
The online nomogram provides a convenient framework for individualized recurrence risk estimation. Further external multicenter validation is warranted to assess its generalizability and clinical applicability.
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BibTeX
@article{zhang2026risk,
title = {{Risk factors for postoperative recurrence of chronic subdural hematoma and construction and validation of an online dynamic nomogram prediction model.}},
author = {Xiangyu Zhang and Zhicheng Huang and Sai Li and Binghui Wu and Mingjun Li and Hongliang Wang and Bing Zhao and Zhifei Guo},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1877761},
url = {https://europepmc.org/article/MED/42908731},
note = {CC BY},
}
RIS
TY - JOUR
TI - Risk factors for postoperative recurrence of chronic subdural hematoma and construction and validation of an online dynamic nomogram prediction model.
AU - Xiangyu Zhang
AU - Zhicheng Huang
AU - Sai Li
AU - Binghui Wu
AU - Mingjun Li
AU - Hongliang Wang
AU - Bing Zhao
AU - Zhifei Guo
PY - 2026
DA - 2026/10/07
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1877761
UR - https://europepmc.org/article/MED/42908731
AB - Objective To investigate factors associated with postoperative recurrence in patients with chronic subdural hematoma (CSDH) and to construct and internally validate an online dynamic nomogram for individualized recurrence-risk estimation.Methods This retrospective single-center study included 284 surgically treated patients with CSDH between January 2018 and May 2025. Before model development, the cohort was divided at a 7:3 ratio into a training cohort (n = 198) and a validation cohort (n = 86). Univariate analysis, multivariable logistic regression, predictor selection, and nomogram construction were performed exclusively in the training cohort, whereas the validation cohort was reserved for model performance assessment. Recurrence was defined as reaccumulation or enlargement of the hematoma on postoperative CT within 6 months after surgery, accompanied by recurrent or worsening neurological symptoms, regardless of whether repeat surgery was subsequently performed.Results Overall, 54 of 284 patients (19.01%) experienced recurrence; 33 recurrence events occurred in the training cohort and 21 in the validation cohort. Smoking history, laterality, hematoma density, greatest hematoma thickness, cerebral midline shift ≥10 mm, and postoperative pneumocephalus were statistically significant in the multivariable analysis. The AUC was 0.89 (95% CI, 0.82-0.95, sensitivity 0.82, specificity 0.85) in the training cohort and 0.74 (95% CI, 0.59-0.88, sensitivity 0.52, specificity 0.85) in the validation cohort. Bootstrap optimism correction yielded an apparent AUC of 0.892, a mean optimism of 0.021, and an optimism-corrected AUC of 0.871. In the training cohort, the Hosmer-Lemeshow test showed no statistically significant evidence of lack of fit (χ ² = 9.96, df = 8, p = 0.268).Conclusion The online nomogram provides a convenient framework for individualized recurrence risk estimation. Further external multicenter validation is warranted to assess its generalizability and clinical applicability.
SN - 1664-2295
ER -