Development and validation of a predictive model for bile leakage after choledochal cyst excision in children: A multicenter retrospective cohort study.
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OBJECTIVE: Bile leakage is one of the most common complications after choledochal cyst surgery in children. Early detection and prevention of this complication are crucial for improving outcomes. This study aimed to develop and validate a nomogram for early prediction of postoperative bile leakage in pediatric patients. METHODS: This retrospective study included children who underwent choledochal cyst surgery at two tertiary pediatric centers in China between 2012 and 2023. The development cohort (n = 1,700) from the Capital Institute of Pediatrics was randomly divided into training and internal validation sets at a 7:3 ratio. Independent predictors were selected using LASSO regression, and a multivariable logistic regression model was established to construct a predictive nomogram. External validation was performed using an independent cohort (n = 1,014) from the Children's Hospital of Chongqing Medical University. Model performance was evaluated for discrimination, calibration, and clinical utility. RESULTS: Postoperative bile leakage occurred in 1.8 % of patients in the development cohort and 3.3 % in the external validation cohort. LASSO regression identified perioperative biliary infection, preoperative white blood cell count, anastomotic diameter, and patient age as independent predictors of bile leakage. The final model demonstrated strong discriminatory ability, with AUCs of 0.83 (95 % CI: 0.65-1.00) in the training set, 0.85 (95 % CI: 0.78-0.91) in the internal validation set, and 0.82 (95 % CI: 0.74-0.91) in the external validation set. The calibration and decision curve analysis (DCA) curves showed good discrimination ability and clinical applicability. CONCLUSIONS: A nomogram based on perioperative clinical factors was developed to predict postoperative bile leakage in children undergoing choledochal cyst surgery. It provides clinicians with an accurate and practical tool for early risk identification and timely management of postoperative complications.