老年股骨转子间骨折术后严重并发症预测模型的构建及验证

Construction and validation of a model for predicting postoperative severe complications of intertrochanteric fracture in the elderly

背景:准确的围术期风险预测至关重要,目前针对老年股骨转子间骨折术后发生严重并发症的预测模型较少,医生和患者的临床决策缺乏依据,此次研究旨在开发针对老年股骨转子间骨折发生术后严重并发症的列线图,指导围术期临床决策。目的:探讨老年股骨转子间骨折发生术后严重并发症的危险因素,并构建风险预测模型。方法:回顾性分析2019年1月至2022年4月新疆维吾尔自治区人民医院老年股骨转子间骨折患者519例的临床资料,记录纳入患者的人口特征、术前化验指标和手术变量,研究结局为术后是否发生严重并发症。采用向前逐步法及似然比检验进行最佳预测模型的筛选,通过受试者工作特征曲线、Hosmer-Lemeshow拟合优度检验、决策曲线分析对模型进行准确性和稳定性评估,并绘制诺莫图。结果与结论:(1)美国麻醉医师协会分级、改良5项衰弱指数评分、C-反应蛋白与白蛋白比值、术前血红蛋白、年龄是老年股骨转子间骨折发生术后严重并发症的重要危险因素;(2)预测模型验证结果显示:建模组发生术后严重并发症的受试者工作特征曲线下面积为0.786,95%置信区间为0.722-0.850;验证组发生术后严重并发症的受试者工作特征曲线下面积为0.725,95%置信区间为0.640-0.808;(3)建模组和验证组Hosmer-Lemeshow拟合优度检验的P值分别为0.738和0.581,证明模型校准度良好;(4)决策曲线分析显示:当建模组和验证组的阈值概率分别为8%-58%和11%-54%时,对老年股骨转子间骨折患者进行临床干预后可能受益;(5)此次研究提出了一种有效的预测模型,该模型有助于个体化预测老年股骨转子间骨折术后严重并发症的发生,帮助临床医师采取个性化治疗措施。

BACKGROUND:Accurate perioperative risk prediction is very important.At present,there are few prediction models for severe complications of intertrochanteric fracture in the elderly,and the clinical decision-making of doctors and patients lacks basis.The purpose of this study is to develop a nomogram for severe complications of intertrochanteric fracture in the elderly,and to guide the perioperative clinical decision-making.OBJECTIVE:To explore the risk factors of severe postoperative complications of intertrochanteric fracture in the elderly and to establish a risk prediction model.METHODS:A retrospective study was conducted on clinical data of 519 elderly patients with intertrochanteric fracture in the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to April 2022.The demographic characteristics,preoperative laboratory indicators and surgical variables of the included patients were recorded.Study outcome was the occurrence of serious complications after operation.The forward stepwise method and likelihood ratio test were used to screen the best prediction model.The accuracy and stability of the model were evaluated through the receiver operator characteristic curve,Hosmer-lemeshow goodness of fit test and decision curve analysis,and nomograms were drawn.RESULTS AND CONCLUSION:(1)American Society of Anesthesiologists classification,5-factor Modified Frailty Index,ratio of C-reactive protein to albumin,preoperative hemoglobin,and age were important risk factors for serious postoperative complications of intertrochanteric fracture in the elderly.(2)The validation results of the predictive model showed that the area under the receiver operator characteristic curve of severe postoperative complications in the modeling group was 0.786,95%confidence interval(0.722-0.850).The area under the receiver operator characteristic curve of severe postoperative complications in the validation group was 0.725,95%confidence interval(0.640-0.808).(3)The P values of Hosmer-lemeshow goodness of fit test in modeling group and validation group were 0.738 and 0.581,respectively,which proved that the models were well calibrated.(4)Decision curve analysis showed that elderly patients with intertrochanteric fractures might benefit from clinical intervention when the threshold probabilities of the modeling group and validation group were 8%-58%and 11%-54%,respectively.(5)This study presents an effective prediction model,which is helpful to predict the occurrence of serious postoperative complications of elderly intertrochanteric fractures and help clinicians take personalized treatment measures.