基于倾向性评分匹配的髋关节术后肺炎危险因素

Risk factors of pneumonia after hip joint surgery based on propensity score matching

目的探讨髋关节手术患者术后肺炎(POP)的危险因素,评价倾向性评分匹配(PSM)在回顾性资料处理中的应用价值。方法收集某院骨关节科自2018年1月1日—2019年12月31日共1141例髋关节手术患者的资料,应用倾向性评分(PS)对髋关节术后患者资料进行分析。结果1141例髋关节手术患者出现POP共102例,发生率为8.94%.PSM前,骨折患者和未骨折患者POP发生率比较,差异无统计学意义(P>0.05)。PSM前,骨折患者和未骨折患者的性别、年龄、麻醉方式、谵妄痴呆、ASA分级、恶性肿瘤、糖尿病、心血管病的8个协变量比较,差异均有统计学意义(均P<0.05)。PSM后,以上8个协变量在两组间分布都达到均衡(均P>0.05)。经过logistic多因素分析显示:年龄>65岁、有慢性阻塞性肺疾病的病史、骨折是髋关节手术患者发生POP的独立危险因素(均P<0.05);与全身麻醉比较,椎管内麻醉是髋关节手术患者发生POP的独立保护因素(P<0.05)。结论PSM法能有效降低观察性研究组间的混杂偏倚。骨折是引起髋关节手术患者POP的危险因素之一。

Objective To evaluate the risk factors for post-operative pneumonia(POP)in patients undergoing hip joint surgery,evaluate the application value of propensity score matching(PSM)in processing of retrospective data.Methods Data of 1141 patients undergoing hip joint surgery from January 1,2018 to December 31,2019 in the department of orthopedics and joint surgery of a hospital were collected,data of patients after hip joint surgery were analyzed by propensity score.Results There were 102 cases of POP among 1141 hip joint surgery patients,incidence was 8.94%.Before PSM,there was no significant difference in POP incidence between fracture patients and non-fracture patients(P>0.05).Before PSM,there were significant differences in 8 covariates,including gender,age,anesthesia,delirium and dementia,ASA classification,malignant tumor,diabetes and cardiovascular disease between fracture patients and non-fracture patients(all P<0.05).After PSM,distribution of the above 8 covaria-tes reached equilibrium between two groups(all P>0.05).Logistic multivariate analysis showed that age>65 years old,history of chronic obstructive pulmonary disease and fracture were independent risk factors for POP in hip joint surgery patients(all P<0.05);compared with general anesthesia,intravertebral anesthesia was an indepen-dent protective factor for POP in hip joint surgery patients(P<0.05).Conclusion PSM method can effectively reduce the confounding bias among groups in observational study.Fracture is one of the risk factors for POP in hip joint surgery patients.