Development and internal validation of a nomogram to predict postoperative vascular crisis in digit replantation: A retrospective cohort study

Objective Vascular crisis is a critical complication that adversely affects digit survival after replantation. This study aimed to develop an individualized predictive nomogram to estimate the risk of postoperative vascular crisis following digit replantation. Methods In this retrospective cohort study, we collected the clinical data of patients who underwent digit replantation at Norinco General Hospital between January 2017 and April 2025. Candidate predictors were screened using least absolute shrinkage and selection operator regression, and multivariable logistic regression was performed to identify the independent risk factors. A nomogram was constructed based on the independent risk factors. Model performance was evaluated using the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis. Internal validation was conducted using bootstrap resampling. Results Three independent predictors were identified using multivariable logistic regression analysis, and a nomogram for predicting postoperative vascular crisis after digit replantation was established. The nomogram demonstrated good discriminative ability, with an area under the receiver operating characteristic curve of 0.80. Calibration curves revealed good agreement between the predicted probabilities and observed outcomes, and decision curve analysis indicated that the nomogram had favorable clinical utility in risk stratification. Conclusions The nomogram demonstrates reliable performance in predicting postoperative vascular crisis after digit replantation and may serve as a practical tool for clinical risk assessment.