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The authors have addressed the reviewers' concerns properly and revised the manuscript accordingly. The manuscript can be accepted for publication in its current form.
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Authors should revise according to the suggestions of reviewers. The modifications should be marked. A point-to-point response letter is needed.
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The authors have addressed all comments.
No further comments.
No further comments.
The authors stated that present model was a preoperative predictive model, and they used preoperative laboratory indicators. However, several variables (operation duration, and abdominal air pressure) can only be obtained after surgery. So, I don't think this is a preoperative predictive model.
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Authors should revise according to the suggestions of reviewers. The modifications should be marked. A point to point response letter is needed.
[# PeerJ Staff Note: Please ensure that all review and editorial comments are addressed in a response letter and any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate. #]
[# PeerJ Staff Note: The review process has identified that the English language must be improved. PeerJ can provide language editing services - please contact us at copyediting@peerj.com for pricing (be sure to provide your manuscript number and title) #]
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In this work, the authors have investigated the risk factors associated with lower extremity deep vein thrombosis (LEDVT) and established a predictive model for patients who undergo
gynecologic laparoscopic surgery. However, we believe that LEDVT is only a complication after gynecologic laparoscopic surgery, and these are two themes. The author should only establish a prediction model for LEDVT. In addition, there is a significant difference between the number of people who have experienced complications and those who have not, and the bias of the study is too large. The results of the article are not credible.
More detailed information on the background of LEDVT and gynecological laparoscopic surgery, for example, the prevalence and incidence of LEDVT and gynecological laparoscopic surgery, should be included which would be beneficial for readers to understand the impact of this research. The authors should expand upon the knowledge gap being filled. In addition, the reported p-values should be more accurate. Some of the p-values in Tables 1 and 2 were 0.000 instead of the exact value and needed to be corrected.
The statistical analysis section is unclear. The authors failed to mention the training and testing datasets used for model building. The bootstrapping approach alone is insufficient to build the nomogram model proposed by the authors as there is an issue with double-dipping for the dataset. In addition, some of the variables used in the multivariate analyses are highly correlated, such as weight and BMI. Many researches have shown that the stepwise approach cannot handle highly correlated variables very well when conducting the variable selection.
In addition to the issues mentioned above for the statistical analysis, the authors should compare the performance of the nomogram model against the existing scores in the field, for example, the Caprini score and Padua score mentioned in the introduction. The authors should also consider the contributions of biochemical indicators by comparing a model with biochemical indicators alone vs. the current nomogram model.
I commend the authors for their extensive dataset compiled over the couple of years of detailed fieldwork. In addition, the manuscript is clear. However, the authors should expand on the introduction by stating the impact of their work to the field. More importantly, the statistical analysis and validity of the findings as I have mentioned above should be improved significantly before acceptance.
This study aimed to build a nomogram model for predicting lower extremity deep vein thrombosis after gynecologic laparoscopic surgery. The topic is interesting and of great importance. However, several issues need to be addressed.
1. This is a retrospective study, VTE events that were asymptomatic or occurred after discharge were likely to be missed, and VTE incidence might be underestimated.
2. In clinical practice, Caprini score is widely used for predicting postoperative VTE. I wonder whether the prediction performance of present nomogram is better than the Caprini score for VTE prediction after gynecologic laparoscopic surgery.
3. Can anaesthesia time or type influence the onset of VTE?
4. Drug information, such as oral contraceptive, etc., can also lead to onset of VTE and have an impact on the prediction model.
5. In this study, whether the laboratory indicators were preoperative or postoperative? I think postoperative ones are more relevant with LEDVT after surgery.
6. Language needs to be polished.
kindly see above.
kindly see above.
kindly see above.
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