摘要
目的建立预测脊柱术后手术部位感染(surgical site infection,SSI)发生风险的诺模图模型,以帮助医务人员制定预防策略,降低SSI的发生率。方法回顾性选择2012年5月至2019年5月在温州市人民医院接受脊柱手术的患者2348例。采用单因素和多因素回归模型确定脊柱手术后SSI的独立预测因素,并根据预测因素构建预测脊柱手术后SSI的诺模图。采用受试者工作特征曲线下面积(AUC)评价诺模图的分辨度,采用校准图和Hosmer-Lemesshow拟合优度检验(H-L检验)检验诺模图的一致性。结果单因素和多因素分析显示,目前吸烟(OR=2.242,95%CI:1.125~4.469)、糖尿病(OR=0.932,95%CI:1.260~5.113)、手术时间≥180 min(OR=7.256,95%CI:3.537~14.886)、ASA≥Ⅲ级(OR=2.963,95%CI:1.454~6.037)、输血(自体血OR=3.685,95%CI:1.203~11.284;异体血OR=6.443,95%CI:2.765~15.017)为脊柱手术后发生SSI的独立预测因素。基于上述预测因素建立的诺模图模型的AUC值为0.818(95%CI:0.802~0.863)。校准图和H-L检验(χ2=12.337,P=0.195)均表明,预测结果与观察结果具有良好的一致性。结论根据目前吸烟、糖尿病、手术时间、ASA分级以及输血等5个预测因素建立的诺模图模型在预测脊柱术后手术部位感染方面具有潜在的临床应用价值。
Objective To develop a nomogram to predict surgical site infection(SSI)after spinal surgery,so as to help medical staff to plan preventive strategies to reduce the incidence of SSI.Methods We retrospectively selected 2348 patients undergoing spinal surgery at Wenzhou People's Hospital from May 2012 to May 2019.Univariate and multivariate logistic regression models were used to determine independent predictors for SSI after spinal surgery and a nomogram was constructed to predict SSI after spinal surgery based on each predictive factor.The area under the receiver operating characteristic curve(AUC)was used to assess the discriminatory ability of the nomogram and the consistency of the nomogram was tested using calibration plot and Hosmer-Lemeshow goodness of fit test(H-L test).Results In univariate and multivariate analysis,current smoking(OR=2.242,95%CI:1.125-4.469),diabetes(OR=0.932,95%CI:1.260-5.113),operation time≥180 min(OR=7.256,95%CI:3.537-14.886),ASA≥grade III(OR=2.963,95%CI:1.454-6.037)and blood transfusion(autologous blood OR=3.685,95%CI:1.203-11.284;allogeneic blood OR=6.443,95%CI:2.765-15.017)were identified as significant independent predictors.The nomogram was developed using these independent predictors.The AUC of the multivariate model for discrimination was 0.818(95%CI:0.802-0.863).The calibration plot and H-L test(χ2=12.337,P=0.195)showed good consistency between predicted and observed outcomes.Conclusion The nomogram based on smoking,diabetes,operation time,ASA classification and blood transfusion has potential as a clinically useful predictive tool of SSI after spinal surgery.
作者
周佩敏
郑舒
黄志红
王大风
Zhou Peimin;Zheng Shu;Huang Zhihong;Wang Dafeng(Department of Orthopedics, Wenzhou People's Hospital, Wenzhou 325000, China)
出处
《中国医院统计》
2021年第1期1-5,共5页
Chinese Journal of Hospital Statistics
基金
温州市公益性科技计划项目(Y20180339)。
