The influencing factors and predictive model construction of postoperative rebleeding in patients with hypertensive basal ganglia hemorrhage in the basal ganglia region after neuroendoscopic surgery

Wang Zhongwei; Wu Huanli; Yang Fei

doi:10.11850/j.issn.1009-122X.2023.12.022

Abstract：Objective To analyze the influencing factors of postoperative rebleeding in patients with hypertensive basal ganglia hemorrhage(HBGH)in the basal ganglia region and construct a predictive model.Methods A retrospective analysis was conducted on 210 HBGH patients who underwent neurosurgery.The patients were divided into the rebleeding group(n=38)and the control group(n=172)based on the postoperative rebleeding.The data of the two groups were compared,and a regression model was established to analyze the influencing factors of rebleeding after neurosurgery for HBGH.Based on the main factors obtained from the regression model analysis,a column chart prediction model was constructed,and calibration curve and decision curve were used to evaluate the predictive value of the model.Results Low GCS score at admission,large hematoma volume,short time from onset to surgery,and high preoperative fibrinogen(FIB)level were identified as risk factors for rebleeding after neurosurgery for HBGH(P<0.05).A ROC curve was constructed based on these risk factors,and it was found that patients with low GCS score,large hematoma volume,and short time from onset to surgery,and high preoperative FIB level had a higher risk of postoperative bleeding.The model was validated using bootstrap and internal validation,and a standard curve,calibration curve,and Y-X straight line were drawn.The C index was 0.988,and the net benefit rate of the decision curve was the maximum at 0.181.The model had good accuracy and discriminatory ability.Conclusions Low GCS score,large hematoma volume,short onset to surgery time,and high preoperative FIB level at admission may be risk factors for postoperative rebleeding in HBGH patients undergoing neuroendoscopy.A predictive model constructed based on these risk factors has high predictive value for the occurrence of postoperative rebleeding in HBGH patients undergoing neuroendoscopy.