Risk factors affecting closed drainage incision healing after thoracoscopic surgery in lung cancer patients and nomogram model analysis

Ma Tiantian; Cao Juan; Liu Hairong; Chen Yuyu; Gan Lei; Peng Xue; Xia Yang; Wang Aimei

doi:10.11986/j.issn.1673-873X.2025.09.10

Abstract：Objective To explore the risk factors affecting the healing of closed drainage incisions after thoracoscopic surgery in lung cancer patients and to construct a nomogram prediction model.Methods Clinical data of 204 lung cancer patients who underwent thoracoscopic surgery at the First Affiliated Hospital with Nanjing Medical University from April 2023 to July 2024 were retrospectively analyzed.According to the presence or absence of poor wound healing(PWH),the patients were divided into a good healing group(n=158)and a poor healing group(n=46).Multivariate logistic stepwise regression analysis was used to identify the risk factors for PWH after thoracoscopic surgery in lung cancer patients,and a nomogram model was constructed based on the results.The predictive performance of the nomogram model for PWH was evaluated u-sing receiver operating characteristic(ROC)curves.Results Patients in the poor healing group were more likely to be aged ≥60 years,have combined diabetes,have drainage fluid ≥10 mL/24 hours at catheter insertion,have a drainage dura-tion ≥3 days,have a drainage tube indwelling time ≥5 days,have drainage fluid ≥10 mL/24 hours after tube removal,have incision infection,experience unplanned tube removal,and have lower serum albumin levels as compared with the good healing group,with all differences being statistically significant(P＜0.05).Multivariate analysis showed that combined dia-betes(OR=1.978,95％CI:1.398-2.798),large drainage volume at catheter insertion(OR=2.090,95％CI:1.471-2.968),long drainage duration(OR=2.132,95％CI:1.492-3.046),incision infection(OR=2.751,95％CI:1.812-4.177),and decreased albumin levels(OR=0.386,95％CI:0.253-0.591)were independent risk factors for PWH after thoracoscopic surgery in lung cancer patients(P＜0.05).The concordance index(C-index)of the nomogram model was 0.875(95％CI:0.823-0.927),the goodness-of-fit test x2=8.593,P=0.506,and the slope of the calibration curve was close to 1.The area under the curve(AUC)for the nomogram model in predicting PWH after thoracoscopic surgery in lung cancer patients was 0.856(95％CI:0.811-0.902),with a specificity of 68.98％and sensitivity of 91.03％.Conclusion The main factors influencing closed drainage incision healing after thoracoscopic surgery in lung cancer patients include combined diabetes,drainage volume at catheter insertion,drainage duration,incision infection,and serum albumin levels.The nomogram model based on these factors has high predictive value and can provide a reference for clinical prevention and intervention.