ObjectiveTo explore the risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection and to construct a nomogram prediction model for postoperative paraplegia in these patients. MethodsStanford type A aortic dissection patients admitted to the First Affiliated Hospital with Nanjing Medical University from January 2021 to August 2024 were selected as the research subjects, and the occurrence of postoperative paraplegia was statistically analyzed. LASSO regression was used to screen the predictive factors, and further multivariate Logistic regression analysis was conducted to identify the independent risk factors. A nomogram model was constructed based on R software (4.2.3), and internal validation was performed using the Bootstrap method. ResultsA total of 353 patients with Stanford type A aortic dissection were included, among whom 27 (7.65%) developed paraplegia after surgery. Multivariate logistic regression analysis showed that preoperative hypotension, prolonged cardiopulmonary bypass time, prolonged aortic cross-clamping time, preoperative renal insufficiency, postoperative infection, non-type I spinal cord blood supply, and intraoperative mean arterial pressure <60mmHg were independent risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection (P<0.05). The area under the receiver operating characteristic curve of the nomogram model was 0.920 [95% CI (0.879, 0.961)]; the calibration curve showed that the predicted values of the nomogram model were basically consistent with the actual values (Hosmer-Lemeshow test, χ2=3.201, P=0.921); the decision curve analysis showed that within the threshold probability range of 1% to 100%, the nomogram prediction results had good benefit values for the intervention of postoperative paraplegia in patients with Stanford type A aortic dissection. ConclusionPreoperative hypotension, prolonged cardiopulmonary bypass time, prolonged aortic cross-sectional time, renal insufficiency, postoperative infection, non-type I spinal cord blood supply, and intraoperative mean arterial pressure <60 mmHg are all independent risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection. The nomogram model constructed based on the above risk factors can effectively predict the postoperative paraplegia risk of patients with Stanford type A aortic dissection.