Development and validation of a nomogram for predicting localization-related complications after CT-guided soft hook-wire placement for solitary pulmonary nodules

Background Although the soft hook-wire has been designed to be less traumatic than rigid devices, localization-related complications are still at risk to perioperative safety. This study aimed to find out independent risk factors for these complications in solitary pulmonary nodules patients (SPNs) and create a new nomogram for exact risk stratification. Methods Retrospectively analyzed 244 consecutive patients who underwent CT-guided soft hook-wire localization and subsequently had video-assisted thoracoscopic surgery for SPNs in our department from January 2025 to November 2025. Univariate and multivariate logistic regression analysis was done to find out independent predictors for complications. According to these factors, we developed and evaluated a prognosis nomogram. Results Technical success rate of localization was 100%. Post-procedural complications occurred in 71 (29.1%) patients. Complications were restricted to pneumothorax and pulmonary hemorrhage. After multivariate analysis, it was found that the presence of emphysema (OR: 15.45, P 0.001), nodule location in the right upper lobe (OR: 6.08, P 0.001), and lower platelet count (OR: 0.99, P = 0.012) were all independent risk factors. The well-calibrated model achieved a C-index of 0.80 (95% CI: 0.74–0.86) and demonstrated net clinical benefits across threshold probabilities of 0–0.85. Conclusion The prediction nomogram developed in this study exhibits good accuracy in predicting complications following CT-guided soft hook-wire localization of SPNs and provides an objective tool for clinical staff to assess preoperative risk.