Risk factors and predictive value of lung ultrasound aeration score for postoperative pulmonary complications in pediatric patients undergoing abdominal tumor resection: a prospective observational study

Abstract Background Postoperative pulmonary complications (PPCs) constitute a leading source of perioperative morbidity in children undergoing abdominal malignant tumor resection. However, the risk factors of PPCs in this specific pediatric population remains unclear, and effective predictive tools are lacking. This study aimed to identify the risk factors for PPCs and evaluate the predictive value of the post-anesthesia care unit (PACU) lung ultrasound aeration score (LUSS). Methods This single-center prospective observational study was conducted at a tertiary cancer center in China. Pediatric patients aged 1–18 years scheduled for abdominal malignant tumor resection were enrolled between January 2025 and January 2026. Perioperative clinical data and PACU LUSS measurements were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for PPCs. Receiver operating characteristic (ROC) curve analysis, calibration analysis, and decision curve analysis (DCA) were adopted to quantify the predictive performance of relevant indicators. Results The overall incidence of PPCs was 60.98% (150/246). Multivariate logistic regression analysis confirmed that American Society of Anesthesiologists (ASA) classification (OR = 3.60, 95% CI = 1.77–7.34, P < 0.001), recent resolved upper respiratory tract infection (URI) (OR = 4.71, 95% CI = 1.84–12.08, P = 0.001), duration of mechanical ventilation (OR = 1.01, 95% CI = 1.01–1.01, P = 0.002), and PACU LUSS (OR = 1.29, 95% CI = 1.17–1.42, P < 0.001) were independent risk factors for PPCs. ROC curve analysis revealed that PACU LUSS alone exhibited favorable predictive efficacy for PPCs, with an area under the ROC curve (AUC) of 0.80. A combined predictive model integrating LUSS and the other three independent risk factors yielded an elevated AUC of 0.88. Calibration curves demonstrated strong consistency between predicted and actual PPCs risks, and DCA verified satisfactory clinical utility and net clinical benefit of the combined model. Conclusions PPCs are highly prevalent in pediatric patients undergoing abdominal malignant tumor resection. Higher ASA classification, recent resolved URI, prolonged duration of mechanical ventilation, and elevated PACU LUSS may be associated with an increased risk of PPCs. As a non-invasive bedside assessment tool, PACU LUSS may provide useful predictive information and could potentially assist with perioperative risk stratification and targeted prevention of PPCs in this vulnerable pediatric population.