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

Abstract

Background 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: <0.001), time to surgery (OR: 1.10; P: 0.012), hematocrit (<lower limit; OR: 3.72; P: 0.015), the platelet-to-mean platelet volume ratio (PMR; >44.52; OR: 2.73; P: 0.047), and high-sensitivity C-reactive protein (HCRP; >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.

Association of preoperative nutritional status evaluated by the controlling nutritional status score with walking independence at 180 days postoperatively: a prospective cohort study in Chinese older patients with hip fracture

“…The investigators performed routine follow-up at 2 weeks, 1 month, 3 months, 6 months, and 12 months postoperatively through telephone interviews or outpatient reviews. The database has been used by numerous orthopedic researchers 33 – 40 , and the information is more accurate than in the administration databases due to manual collection and update.…”

Incorporating preoperative frailty to assist in early prediction of postoperative pneumonia in elderly patients with hip fractures: an externally validated online interpretable machine learning model

“…Firstly, preoperative CRP reflects the inflammatory status of the patient. Although it is a nonspecific marker of systemic inflammation, it has been proven to be a predictive variable of postoperative infection (including pneumonia, surgical site infection, and urinary tract infection) and mortality in hip fracture patients [ 35 , 36 ]. Our study further confirmed the predictive role of CRP on the occurrence of independent POP infection rather than postoperative overall infection symptoms in elderly patients with hip fractures, with its contribution value to the prediction model ranked first.…”

Relationship between preoperative red blood cell distribution width and postoperative pneumonia in elderly patients with hip fracture: a retrospective cohort study

“…Hence, we could only adjust for measurable confounders but not for unmeasurable ones. For example, our study did not collect information on whether the patients had consumed alcohol [ 44 ] or previously had pneumonia; furthermore, preoperative laboratory markers (e.g., C-reactive protein and erythrocyte sedimentation rate were not collected [ 45 , 46 ]). These variables are risk factors for POP, and could have affected the accuracy of our results.…”