Incidence and nomogram for postoperative pulmonary infection in pediatric patients following major abdominal surgery: A comprehensive analysis

Postoperative pulmonary infection (POI) is a major complication in pediatric patients following major abdominal surgery, yet our understanding of the perioperative features that contribute to POI remains limited. In this study, we developed a nomogram to estimate the risk of POI in pediatric patients after such surgeries. A total of 1238 pediatric patients who underwent major abdominal surgery were enrolled and retrospectively investigated. We analyzed perioperative parameters to construct a nomogram for predicting postoperative POI. The model's concordance (C-index) and discrimination capability were assessed using the concordance index, calibration curves, and receiver operating characteristic analysis. Out of the 1075 patients included in the analysis, 91 pediatric patients developed postoperative POI. Independent predictors for POI, identified through multivariable logistic regression analysis, included fever >37.5°C, prolonged operation time (in hours), lymphocyte-to-C-reactive protein ratio, emergency surgery, and intraoperative blood transfusion. A nomogram incorporating these 5 variables was developed, demonstrating good concordance and discrimination capability. The predictive accuracy was validated by receiver operating characteristic analysis, with a sensitivity of 87.6% and a specificity of 78.9%. We successfully developed a nomogram, a clinical decision-making tool, to accurately identify pediatric patients at risk for postoperative POI. Physicians managing these patients should consider these variables to optimize postoperative recovery.