Risk factors for compensatory hyperhidrosis following CT-guided percutaneous radiofrequency sympathectomy: A retrospective observational study

Compensatory hyperhidrosis (CH) is a significant complication following surgery for primary hyperhidrosis, impairing patients' postoperative experience and quality of life. Radiofrequency sympathectomy (RFS) is one of the main minimally invasive surgeries for hyperhidrosis, yet high-risk factors and patient experiences of postoperative CH are rarely reported. This retrospective observational study (Strengthening the Reporting of Observational Studies in Epidemiology compliant) aimed to identify significant risk factors for CH after RFS and to develop a dynamic nomogram for individualized risk prediction. A total of 410 primary hyperhidrosis patients who underwent RFS between January 2018 and March 2023 were enrolled. A CH database was established via systematic follow-up to track postoperative sweating patterns. Detailed clinical assessments included the Numeric Rating Scale (NRS), Hyperhidrosis Disease Severity Scale (HDSS), and Hospital Anxiety and Depression Scale (HADS). Advanced statistical techniques, including logistic regression analysis, were used to identify potential risk factors for CH. Of the 410 patients, 281 (68.5%) developed CH, with 105 (25.6%) reporting moderate-to-severe symptoms. Multivariate analysis revealed 4 significant predictors of CH: male gender (odds ratio [OR] = 1.69); higher NRS scores (OR = 1.16); lower immediate postoperative HDSS (OR = 0.48); higher preoperative HADS scores (OR = 1.11). A dynamic, web-based nomogram was also developed to provide personalized CH risk prediction. Male gender, higher intraoperative NRS scores, lower immediate postoperative HDSS, and higher preoperative HADS scores were identified as independent risk factors. The constructed dynamic nomogram enables individualized risk prediction and supports clinicians in providing personalized preoperative counseling and perioperative management for patients undergoing RFS.