髋部骨折术后手术部位感染的危险因素分析及列线图预测模型的建立

Analysis of risk factors for early surgical site infection after hip fracture surgery based on nomogram and establishment of a nomogram prediction model

目的:分析髋部骨折术后手术部位感染(SSI)的危险因素,并构建列线图预测模型。方法:回顾性分析2018—2023年在北京协和医院接受手术治疗的1118例髋部骨折患者的临床资料。收集两组患者性别、体重指数(BMI)、术前血液学检测指标等。通过单因素和多因素logistic回归分析筛选髋部骨折术后SSI的危险因素,而后基于筛选出的危险因素构建列线图预测模型。结果:1118例患者中,1.6%(18/1118)的患者髋部骨折术后发生SSI。单因素和多因素logistic回归分析结果显示,男性、吸烟、BMI、术前白蛋白水平是髋部骨折术后SSI的危险因素。基于这些危险因素构建列线图预测模型,预测模型的一致性指数为0.946[95%置信区间(95%CI):0.865~0.962],校准曲线显示预测发生率曲线与实际发生率曲线有良好的一致性。结论:本研究建立了基于性别、吸烟史、BMI、术前白蛋白水平的髋部骨折术后SSI的列线图预测模型,可较为准确地预测髋部骨折患者术后SSI的发生率。

Objective:To investigate the risk factors for early surgical site infection(SSI)in patients after hip fracture surgery and to establish a nomogram prediction model.Methods:A retrospective analysis was conducted on the clinical data of 1118 patients who underwent hip fracture surgery from 2018 to 2023 in Peking Union Medical College Hospital.Clinical data,including gender,body mass index(BMI),surgical segment,and preoperative hematological examination results,were collected.Multivariate logistic regression analysis was employed to identify risk factors for SSI.Subsequently,a nomogram was constructed based on the identified risk factors,and a calibration curve model was developed.Results:Among the 1118 patients,1.6%(18/1118)developed early SSI after hip fracture surgery.Multivariate logistic regression analysis indicated that male gender,smoking,BMI,and preoperative albumin levels were risk factors for early postoperative SSI.A nomogram was constructed based on these risk factors,with a concordance index of 0.946(95%confidence interval[95%CI]:0.865-0.962).The calibration curve showed good consistency between the predicted and observed incidence rates.Conclusions:This study established a nomogram model based on gender,smoking history,BMI,and preoperative albumin levels to predict the incidence of early SSI after hip fracture surgery.This predictive model can accurately predict the incidence rate of early postoperative SSI in hip fracture patients.