当前位置: X-MOL 学术Geriatr. Orthop. Surg. Rehabilit. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Postoperative Pneumonia in Geriatric Patients With a Hip Fracture: Incidence, Risk Factors and a Predictive Nomogram
Geriatric Orthopaedic Surgery & Rehabilitation ( IF 1.6 ) Pub Date : 2022-03-23 , DOI: 10.1177/21514593221083824
Xin Zhang 1 , Zhi-Long Shen 2 , Xu-Zhou Duan 3 , Qi-Rong Zhou 3 , Jie-Fu Fan 2 , Jie Shen 2 , Fang Ji 4 , Da-Ke Tong 4
Affiliation  

ObjectivesTo evaluate the incidence and risk factors of postoperative pneumonia (POP) in geriatric patients with a hip fracture after surgery, to design a predictive nomogram, and to validate the accuracy of the nomogram.DesignRetrospective study.SettingA tertiary hospital affiliated to a medical university.Patients/ParticipantsWe retrospectively studied 1285 surgical-treated geriatric patients with a hip fracture from April 2010 to April 2018.InterventionSurgical treatment was performed on the patients of this study. The procedure methods were classified as: total hip arthroplasty, hemiarthroplasty, percutaneous fixation, intramedullary nail fixation, and plate/screw fixation.Main Outcome MeasurementThe primary interest of end point of this study is the development of POP during the postoperative period. The postoperative period in this study was defined as the time from 24 hours after surgery to discharge. The diagnostic criteria for pneumonia were set according to the guidelines built by the Infectious Diseases Society of America and the American Thoracic Society (Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia, 2005). Potential variables for developing POP were identified using logistic regression analyses initially and were further selected via the method of LASSO. Then the independent risk factors were identified by multivariable regression analyses. A predictive nomogram was built based on the multiple regression model, and the calibration abilities of the nomogram was measured by Harrel C-index, calibration plot and Hosmer–Lemeshow test, respectively. Decision curve analysis was carried out to assess the net benefit due to threshold probability and an on-line questionnaire survey was conducted among the clinicians to assess the applicability of the nomogram coherently.ResultsOf the 1285 patients, 70 (5.4%) developed POP. COPD, number of comorbidities, ASA classification >2, preoperative dependent functional status and cognitive impairment were identified as independent risk factors of POP. The nomogram built based on the results showed good accordance between the predicted probabilities and the observed frequency. The decision curve analysis confirmed the clinical utility of the nomogram when the threshold probabilities were between 5% and 65% due to the net benefit, while the results of on-line questionnaire among 200 clinicians showed that 91.5% of the participants had a mental threshold of intervention between 5-50%.Conclusion(1). COPD, number of comorbidities, ASA classification >2, preoperative dependent functional status and cognitive impairment are independent risk factors for POP. (2). The nomogram built in this study has a good accordance between the predictive risk and the observational incidence. The results of decision curve and questionnaire among clinicians show well applicability of the nomogram.

中文翻译:

髋部骨折老年患者的术后肺炎:发病率、危险因素和预测列线图

目的评价老年髋部骨折患者术后肺炎(POP)的发生率及危险因素,设计预测列线图,并验证列线图的准确性。设计回顾性研究。设置某医科大学附属三级医院。患者/参与者我们回顾性研究了 2010 年 4 月至 2018 年 4 月期间接受手术治疗的 1285 名髋部骨折老年患者。干预对本研究的患者进行了手术治疗。手术方法分为:全髋关节置换术、半髋关节置换术、经皮固定、髓内钉固定和钢板/螺钉固定。主要结果测量本研究的主要终点是术后POP的发展。本研究中的术后时间定义为术后24小时至出院的时间。肺炎的诊断标准是根据美国传染病学会和美国胸科学会制定的指南(成人医院获得性、呼吸机相关和医疗保健相关肺炎的管理指南,2005 年)制定的。最初使用逻辑回归分析确定了发展 POP 的潜在变量,并通过 LASSO 方法进一步选择。然后通过多变量回归分析确定独立危险因素。基于多元回归模型构建预测列线图,并分别通过Harrel C-index、校准图和Hosmer-Lemeshow检验测量列线图的校准能力。进行决策曲线分析以评估阈值概率的净收益,并在临床医生中进行在线问卷调查,以一致地评估列线图的适用性。结果 1285 例患者中,70 例(5.4%)发生 POP。COPD、合并症数量、ASA分类>2、术前依赖性功能状态和认知障碍被确定为POP的独立危险因素。基于结果构建的列线图显示了预测概率和观察到的频率之间的良好一致性。决策曲线分析证实了当阈值概率在 5% 和 65% 之间时列线图的临床效用,因为净收益,而 200 名临床医生的在线问卷结果显示,91. 5%的参与者的心理干预阈值在5-50%之间。结论(1)。COPD、合并症数量、ASA分类>2、术前依赖性功能状态和认知障碍是POP的独立危险因素。(2)。本研究中建立的列线图在预测风险和观察发生率之间具有良好的一致性。临床医生的决策曲线和问卷结果表明列线图具有很好的适用性。
更新日期:2022-03-23
down
wechat
bug