# Establishment and validation of a nomogram to predict thirty-day unplanned reoperations of primary anastomosis in neonates with intestinal atresias

## TL;DR

This study creates a tool to predict if neonates with intestinal atresia will need unplanned reoperations after surgery, helping doctors make better decisions.

## Contribution

The novel contribution is a validated nomogram to predict unplanned reoperations after primary anastomosis in neonates with intestinal atresia.

## Key findings

- The thirty-day unplanned reoperation rate was 11% in neonates with intestinal atresia.
- Type of bowel anastomosis and combined meconium peritonitis were significant predictors of unplanned reoperations.
- The nomogram demonstrated good discrimination (C-index 0.791) and calibration.

## Abstract

Unplanned reoperation rates becoming a critical metric for evaluating healthcare quality and have received increasing attention in recent years. Intestinal atresia (IA) has a high rate of unplanned reoperations. The purpose of this study is to evaluate the thirty-day unplanned reoperation rates and their risk factors in neonates with intestinal atresias after primary anastomosis surgery, and to construct a predictive nomogram.

We developed and internally validated a predictive model from a retrospective cohort of 200 neonates admitted to our hospital for primary anastomosis surgery. The primary outcome was thirty-day unplanned reoperation rates. Independent factors significantly associated with thirty-day unplanned reoperation rates were identified using multivariable logistic regression analysis. The effectiveness of the developed nomogram was evaluated through calibration, discrimination, and clinical utility.

The incidence of thirty-day unplanned reoperation rates was 11%. Multivariable analysis identified the type of bowel anastomosis and combined meconium peritonitis as independent factors predicting thirty-day unplanned reoperation rates. The derivation model showed good discrimination, with a C-index of 0.791 (95% CI, 0.685–0.897), and good calibration (Hosmer–Lemeshow test P = 0.231). The analysis of the decision curve showed that the nomogram was beneficial in clinical practice.

We developed a nomogram to predict thirty-day unplanned reoperations of primary anastomosis in neonates with IA. This prediction model may enable assist in clinical decision-making, patient counseling, and treatment planning.