摘要
目的探讨脊柱手术后发生切口感染的临床危险因素,以及据此构建的预测模型对术后切口感染的预测效能。方法回顾性病例对照研究。纳入2019年1月—2021年1月西安交通大学附属红会医院脊柱手术患者521例,其中男294例、女227例,年龄14~85(45.3±17.6)岁。521例患者中,行脊柱前路手术75例,后路手术402例,前、后路联合手术44例。根据患者术后是否发生切口感染,分为感染组45例和非感染组476例。观察指标:(1)比较2组患者临床基线资料,手术部位、手术范围、手术方式、手术时间、手术出血量、切口缝合方式等指标,对脊柱手术后发生切口感染的影响因素进行单因素分析及多因素logistic回归分析;(2)根据危险因素构建预测脊柱手术后发生切口感染风险的列线图模型,采用受试者操作特征(ROC)曲线、校准曲线、决策曲线评估列线图模型的性能。结果单因素分析显示:患者年龄、术前白蛋白水平、糖尿病史、手术时间及切口缝合方式是脊柱患者术后切口感染的危险因素(P值均<0.05)。多因素logistic分析结果显示:患者年龄、术前白蛋白水平、糖尿病史、手术时间及切口缝合方式是脊柱患者术后切口感染的独立危险因素(P值均<0.05)。根据术后切口感染的危险因素构建列线图预测模型,ROC曲线下面积为0.754(95%可信区间0.678~0.829),灵敏度为71.1%,特异度为73.3%,列线图模型的诊断性能较好;校准曲线显示斜率接近1,列线图模型的校准性能良好;决策曲线显示列线图模型具有良好的临床预测效能;Hosmer-Lemeshow检验评估列线图模型预测值与真实值差异无统计学意义(χ^(2)=14.50,P=0.070)。结论患者年龄、糖尿病史、术前白蛋白水平、手术时间及切口缝合方式是影响脊柱手术患者术后切口感染的独立危险因素。根据危险因素构建的列线图预测模型可提供个性化的术后感染风险评估方法,具有较好的预测效能,可为脊柱术后切口感染的临床预测提供参考。
Objective This study aims to explore the clinical risk factors of incision infection after spinal surgery and the predictive efficacy of the prediction model.Methods In this retrospective case-control study,521 patients with spinal surgery in Xi'an Honghui Hospital from January 2019 to January 2021 were recruited,including 294 males and 227 females,with age ranging from 14 to 85(45.3±17.6)years.Among the 521 patients,75 underwent anterior spinal surgery,402 underwent posterior spinal surgery,and 44 underwent combined anterior and posterior spinal surgery.According to the occurrence of postoperative incision infection,the patients were divided into infection group(45 cases)and non-infection group(476 cases).(1)The two groups of patients were compared in terms of clinical baseline data,surgical site,operation scope,operation method,operation time,blood loss,suture of incision,and operation indicators,such as in spine surgery,to determine factors influencing the infection of incision.Single-factor analysis and multiple-factor analysis after spinal surgery incision infection were conducted to identify independent risk factors(2)A nomogram model was constructed to predict the risk of incision infection after spinal surgery according to the risk factors.(3)The receiver operating characteristic curve(ROC)curve was used to evaluate the discrimination performance of the nomogram model,the calibration curve was used to evaluate the calibration performance of the nomogram model,and the decision curve was used to evaluate the predictive performance of the nomogram model.Results Among the 521 patients,45 patients were finally confirmed to have postoperative incision infection,and the postoperative infection rate was 8.64%.Logistic regression analysis showed that age(P=0.005),history of diabetes(P=0.021),preoperative albumin level(P<0.001),operation time(P=0.017),and incision suture method(P=0.016)were independent risk factors for postoperative incision infection in patients undergoing spinal surgery.According to the risk factors of postoperative incision infection,the nomogram prediction model was constructed,and the AUC of the ROC curve was 0.754(95%CI 0.678-0.829),the sensitivity was 71.1%,the specificity was 73.3%,and the diagnostic performance of the nomogram model was good.The slope of the calibration curve was close to 1,and the calibration performance of the nomogram model was good.The decision curve showed that the nomogram model had good clinical prediction performance.The Hosmer-Lemeshow test revealed no significant difference between the predicted value and the true value of the graph model(χ^(2)=14.50,P=0.070).Conclusion Age,history of diabetes,preoperative albumin level,operation time,and incision suture method are independent risk factors for postoperative incision infection in patients undergoing spinal surgery.The nomogram prediction model constructed according to risk factors can provide personalized postoperative infection risk assessment method.It has good prediction performance and can provide reference for clinical prediction of postoperative incision infection in the spine.
作者
孙杨
单乐群
曾文
郝定均
Sun Yang;Shan Lequn;Zeng Wen;Hao Dingjun(Department of Spinal Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)
出处
《中华解剖与临床杂志》
2023年第5期327-331,共5页
Chinese Journal of Anatomy and Clinics
关键词
外科伤口感染
脊柱疾病
手术后并发症
危险因素
列线图模型
Surgical wound infection
Spinal diseases
Postoperative complications
Risk factors
Nomogram model
