| Objective:The purpose of this study is to analyze the risk factors affecting postoperative hemorrhage in children after tonsillectomy,and to establish a predictive model for the risk of postoperative hemorrhage in children after tonsillectomy.It is helpful for clinicians to identify children with high risk of postoperative hemorrhage after tonsillectomy early,take preventive measures to reduce the incidence of postoperative hemorrhage in children after tonsillectomy and improve the prognosis of children.Methods:A retrospective analysis of 701 children who underwent tonsillectomy in Jining NO.1 People’s Hospital from January 2022 to December 2022 was performed.The clinical data of the children included gender,age,BMI,course of disease,preoperative diagnosis,surgical methods,dietary cooperation,degree of tonsil embedding,and Surgeon qualifications.Statistical analysis was performed on the aspects of surgery.The above risk factors were analyzed by univariate analysis,and the factors with P<0.05 were selected for multivariate logistic regression analysis to further screen out the risk factors related to hemorrhage after tonsillectomy in children,so as to establish a prediction model for predicting the risk of hemorrhage after tonsillectomy in children and draw a Nomogram.Results:The clinical data of 701 children were collected in the study,including 30 cases in the tonsil postoperative hemorrhage group and 671cases in the control group.Statistical analysis showed that there was no significant difference in gender,age,BMI,course of disease,and surgical methods between the two groups(P>0.05).There were statistically significant differences between the two groups in the degree of dietary cooperation,the degree of tonsil embedding,preoperative diagnosis and different qualifications(P<0.05).The clinical indicators related to bleeding in the above univariate analysis were further analyzed by multivariate logistic regression analysis.The results showed that the degree of dietary cooperation(OR=3.994,95%CI:2.074～7.694,P<0.001),tonsil embedding(OR=2.674,95%CI:1.728～4.138,P<0.001),preoperative diagnosis(OR=1.895,95%CI:1.273～2.820,P=0.002<0.05),and the surgeon’s qualifications(OR=9.091,95%CI:3.460～23.890,P<0.001)were independent risk factors for hemorrhage in children after tonsillectomy.The degree of dietary cooperation,the degree of tonsil embedding,preoperative diagnosis and different types of surgeons were used as predictors to establish a risk prediction model for tonsil hemorrhage in children.The results of Hosmer-Lemehow goodness of fit test showed that:χ~2=6.166,P=0.520>0.05,and the area under the curve(AUC)of the model was calculated to be 0.875(95%CI:0.792～0.957),indicating that the model had good fitting degree and good prediction accuracy.The nomogram was drawn using R language and internally tested by 1000.Conclusion:1.We initially constructed a predictive model for the risk of bleeding after tonsillectomy in children,which can be used to predict the risk of bleeding in children with tonsillectomy.2.According to the high risk factors of bleeding in children,and the prediction model suggests that the risk of bleeding in children is high,clinical workers can strengthen communication with the family members of children and enhance mutual trust.3.When the child is diagnosed with chronic tonsillitis or chronic tonsillitis with adenoid hypertrophy before surgery,the degree of tonsil embedding is heavy,the degree of diet coordination is poor,and the surgeon is a beginner,the risk of bleeding after tonsillectomy is higher,which needs our attention.At the same time,when performing surgery on such children,the surgeon’s qualifications are best for senior doctors.At the same time,the intraoperative operation should be careful and gentle,the hemostasis should be more comprehensive,and the postoperative diet should be actively encouraged to eat and supplement nutrition to reduce the incidence of postoperative hemorrhage in children. |
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