老年全膝关节置换患者出院准备度影响因素及列线图预测模型的构建

Influencing factors of discharge readiness in elderly patients with total knee replacement and the construction of a prediction model based on line graph

目的探讨老年全膝关节置换术(TKA)患者出院准备度的影响因素,并构建风险预测列线图模型。方法选择2022年1—5月山东省济南市3所三级甲等医院252例TKA术后患者作为调查对象,根据出院准备度量表条目均分将其分为准备不足组(<7分)和准备良好组(≥7分)。采用单因素和多因素Logistic回归模型,分析筛选影响因素,并以此构建列线图模型。结果252例老年TKA患者出院准备不足的概率为16.27%(41例),多因素Logistic回归分析结果显示,年龄、文化程度、活动后疼痛程度和社会支持是其影响因素(P<0.05)。列线图模型的受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.884,校准曲线显示预测概率与实际概率之间具有良好的一致性,Hosmer-Lemeshow拟合优度检验显示差异无统计学意义(P>0.05)。结论本研究构建的列线图模型可以为临床医护人员早期采取个性化干预措施提高患者的出院准备度提供参考依据。

Objective To explore the influencing factors of discharge readiness in elderly patients undergoing total knee replacement(TKA)and construct a risk prediction line graph model.Methods From January to May 2022,252 patients with TKA surgery in Class III Grade A in Jinan City,Shandong Province were selected as investigation objects.According to the average score of discharge readiness scale items,they were divided into underprepared group(<7 points)and well-prepared group(≥7 points).Single factor and multiple factor Logistic regression models were used to analyze and screen the influencing factors,and then a line graph model was constructed.Results Among 252 elderly patients with TKA,the probability of insufficient preparation for discharge was 16.27%(41 cases).The results of multivariate Logistic regression analysis showed that age,education level,post-activity pain and social support were the influencing factors(P<0.05).The area under the receiver operating characteristic(ROC)curve of the line graph model was 0.884,and the calibration curve showed a good consistency between the predicted probability and the actual probability.Hosmer-Lemeshow goodness of fit test showed no statistical significance(P>0.05).Conclusion The column graph model constructed in this study could provide reference for clinical staffto take personalized intervention measures early to improve patients'readiness for discharge.