Clinical Interventions in Aging (Dec 2022)

Preoperative Risk Factor Analysis and Dynamic Online Nomogram Development for Early Infections Following Primary Hip Arthroplasty in Geriatric Patients with Hip Fracture

  • Cheng X,
  • Liu Y,
  • Wang W,
  • Yan J,
  • Lei X,
  • Wu H,
  • Zhang Y,
  • Zhu Y

Journal volume & issue
Vol. Volume 17
pp. 1873 – 1883

Abstract

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Xinqun Cheng,1,2,* Yan Liu,3,* Weitong Wang,4 Jincheng Yan,1 Xiang Lei,1 Haifeng Wu,1 Yingze Zhang,1,2 Yanbin Zhu1,2 1Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China; 2Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China; 3Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People’s Republic of China; 4Department of Marketing and International Business, Lingnan University, Hong Kong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yingze Zhang; Yanbin Zhu, Hebei Bone Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China, Email [email protected]; [email protected]: Hip arthroplasty is in increasing demand with the aging of the world population, and early infections, such as pneumonia, surgical site infection (SSI), and urinary tract infection (UTI), are uncommon but fatal complications following hip arthroplasty. This study aimed to identify preoperative risk factors independently associated with early infections following primary arthroplasty in geriatric hip fracture patients, and to develop a prediction nomogram.Methods: Univariate and multivariate logistical analyses were performed to identify the independent risk factors for early infections, which were combined and transformed into a nomogram model. The prediction model was evaluated by using the area under the receiver operating characteristic curve (AUC), Hosmer–Lemeshow test, concordance index (C-index), 1000 bootstrap replications, decision curve analysis (DCA), and calibration curve.Results: One thousand eighty-four eligible patients got included and 7 preoperative variables were identified to be independently associated with early infections, including heart disease (odds ratio (OR): 2.17; P: 0.026), cerebrovascular disease (OR: 2.25; P: 0.019), liver disease (OR: 8.99; P: 78.64mg/L; OR: 3.71; P: < 0.001). For the nomogram model, AUC was 0.807 (95% confidence interval (CI): 0.742– 0.873), the Hosmer-Lemeshow test demonstrated no overfitting (P = 0.522), and C-index was 0.807 (95% CI: 0.742– 0.872) with corrected value of 0.784 after 1000 bootstrapping validations. Moreover, the calibration curve and DCA exhibited the tools’ good prediction consistency and clinical practicability.Conclusion: Heart disease, cerebrovascular disease, liver disease, time to surgery, hematocrit, PMR, and HCRP were significant preoperative predictors for early infections following primary arthroplasty in elderly hip fracture patients, and the converted nomogram model had strong discriminatory ability and translatability to clinical application.Keywords: early infections, arthroplasty, hip fracture, geriatric, nomogram

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