| Prediction of postoperative hypokalemia in patients with severe carotid artery stenosis undergoing standard carotid endarterectomy: a retrospective cohort study |
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Suiyuan Hu1, Xuan Lai1, Yunfeng Han2 |
1Department of Geriatrics, Peking University Third Hospital, Beijing, China
2Department of Neurosurgery, Peking University Third Hospital, Beijing, China |
Correspondence:
Yunfeng Han,
Email: hyfln@126.com
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Received: 9 October 2025 • Revised: 27 November 2025 • Accepted: 22 December 2025 |
| Abstract |
Background
Postoperative hypokalemia is a common electrolyte disturbance associated with adverse outcomes, particularly in older adults. This study aimed to identify risk factors and develop predictive models for hypokalemia within 24 hours after carotid endarterectomy (CEA) for severe carotid artery stenosis, a condition that primarily affects older patient populations.
Methods
A retrospective cohort of 1076 CEA patients (October 2021 to May 2023) was analyzed. Risk factors were identified using univariate and multivariate logistic regression. A predictive nomogram was developed and internally validated via bootstrapping. Machine learning models (Random Forest and XGBoost) were developed and interpreted using SHAP analysis. Subgroup analyses were performed in patients aged ≥70 years and by comparing postoperative potassium levels >4.0 mmol/L versus 3.5-4.0 mmol/L.
Results
The cohort had a median age of 65 years. Multivariate analysis identified preoperative potassium (OR = 0.60, 0.50–0.72), hemoglobin (OR = 0.74, 0.63–0.88), BMI (OR = 0.74, 0.63–0.88), and postoperative VAS score (OR = 1.28, 1.09–1.51) as independent predictors. Frailty showed borderline significance (OR = 1.56, 1.00–2.44, p = 0.05). The nomogram achieved an AUC of 0.710, demonstrating good discrimination and calibration. Machine learning models similarly performed well (AUCs: 0.707–0.709).
Conclusion
We developed a validated tool to predict postoperative hypokalemia after CEA. The model highlights that in addition to biochemical and surgical factors, geriatric syndromes like frailty and nutritional status are pivotal risk determinants. This facilitates early, individualized management, including tailored potassium supplementation, nutritional support, and pain control, especially for vulnerable older adults, to mitigate complications and promote recovery. |
| Key Words:
postoperative hypokalemia, carotid endarterectomy, frailty, geriatrics, risk prediction, nomogram |
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