头面部皮瓣修复术后并发症发生风险模型的构建

Construction of risk model for postoperative complications after craniofacial skin flap repair

目的分析头面部皮瓣修复术后并发症发生的危险因素,并建立风险预测模型。方法选择佛山市中医院2017年10月至2020年9月120例行皮瓣修复术患者,单因素和logistic多因素回归分析筛选术后并发症发生的危险因素,并建立个性化预测列线图模型。结果术后并发症发生率为25.83%,其主要的并发症是组织瓣血管危象,其他有感染、皮瓣撕脱、皮下血肿及水肿等。经logistic多因素回归分析,静脉端侧吻合(OR=3.766,95%CI:1.587~8.938)、术中失血过多(OR=2.889,95%CI:1.089~7.668)、吸烟史(OR=4.697,95%CI:1.558~14.161)、医师手术水平(OR=3.062,95%CI:1.183~7.922)及皮瓣设计不当(OR=2.399,95%CI:0.861~6.686)是皮瓣修复术后并发症发生的危险因素(均P<0.05)。基于以上危险因素建立风险列线图模型,C-index指数为0.829(95%CI:0.806~0.853),具有较好的精确度和区分度。结论静脉端侧吻合、术中失血过多、吸烟史、医师手术水平及皮瓣设计不当是皮瓣修复术后并发症发生的危险因素,基于以上建立的风险模型预测精准度较高,对头面部皮瓣修复术后并发症的筛查具有较高的应用价值。

Objective To analyze the risk factors of postoperative complications after craniofacial flap repair,and to establish a risk prediction model.Methods A total of 120 patients who underwent skin flap repair from October 2017 to September 2020 were selected.Univariate and logistic multivariate regression analyses were used to screen the risk factors for complications after skin flap repair,and a personalized predictive nomogram model was established.Results The incidence of postoperative complications was 25.83%.The main complications were flap vascular crisis,infection,flap avulsion,subcutaneous hematoma and edema.Logistic multivariate regression analysis revealed that the risk factors for complications after skin flap repair included venous end-to-side anastomosis(OR=3.766,95%CI:1.587~8.938),excessive intraoperative blood loss(OR=2.889,95%CI:1.089~7.668),smoking history(OR=4.697,95%CI:1.558~14.161),physician′s surgical skill(OR=3.062,95%CI:1.183~7.922)and improper flap design(OR=2.399,95%CI:0.861~6.686)(P<0.05 for all).A risk nomogram model was established based on the above risk factors.The C-index was 0.829(95%CI:0.806~0.853),which had good precision and discrimination.Conclusions Venous end-to-side anastomosis,excessive blood loss during operation,smoking history,surgeon′s surgical skill and improper flap design are the risk factors for complications after flap repair.Risk nomogram model has good precision and discrimination and has high application value.