Development of a novel nomogram to predict the risk of severe compensatory sweating following endoscopic thoracic sympathectomy

Backgrounds: Endoscopic thoracic sympathectomy (ETS) is a permanent and effective treatment for primary hyperhidrosis and facial blushing; however, severe compensatory sweating (SCS) remains a devastating complication. We aimed to (i) construct a nomogram to predict the risk of SCS, and (ii) investigate factors associated with the level of satisfaction. Methods: From Jan 2014 to Mar 2020, 347 patients underwent ETS by a single surgeon. These patients were asked to complete an online questionnaire regarding primary symptom resolution, level of satisfaction, and development of compensatory sweating. Multivariable analysis was conducted via logistic regression and ordinal regression to predict SCS and satisfaction level respectively. Nomogram was developed based on significant predictors. Results: In total, 298 (85.9%) patients responded to the questionnaire with a mean follow up of 4.9 +/- 1.8 years. Significant factors associated with SCS in the nomogram included older age (OR 1.05, 95% CI 1.02-1.09, P = 0.001), primary indication other than palmar hyperhidrosis (OR 2.30, 95% CI 1.03-5.12, P = 0.04), and current smoking (OR 5.91, 95% CI 2.46-14.20, P < 0.001). The area under receiver operating characteristic curve was 0.713. Multivariable analysis revealed that longer follow up (beta = -0.201 +/- 0.078, P = 0.01), gustatory hyperhidrosis (beta = -0.781 +/- 0.267, P = 0.003), primary indication other than palmar hyperhidrosis (beta = -1.524 +/- 0.292, P < 0.001), and SCS (beta = -3.061 +/- 0.404, P < 0.001) were independently associated with a lower degree of patient satisfaction. Conclusion: The novel nomogram can provide a personalized numerical risk estimate to assist both the clinician and patient weigh the pros and cons as part of the decision-making process, mitigating the chance of patient dissatisfaction.