Construction and validation of a model for predicting postoperative severe complications of intertrochanteric fracture in the elderly
Weng Youlin1, Cai Yu2, Li Zutao2, Guo Bin1, Xu Jiangbo2
1Graduate School of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China; 2Department of Traumatic Orthopaedics, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
Abstract: BACKGROUND: Accurate perioperative risk prediction is very important. At present, there are few prediction models for severe complications of intertrochanteric fracture in the elderly, and the clinical decision-making of doctors and patients lacks basis. The purpose of this study is to develop a nomogram for severe complications of intertrochanteric fracture in the elderly, and to guide the perioperative clinical decision-making.
OBJECTIVE: To explore the risk factors of severe postoperative complications of intertrochanteric fracture in the elderly and to establish a risk prediction model.
METHODS: A retrospective study was conducted on clinical data of 519 elderly patients with intertrochanteric fracture in the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to April 2022. The demographic characteristics, preoperative laboratory indicators and surgical variables of the included patients were recorded. Study outcome was the occurrence of serious complications after operation. The forward stepwise method and likelihood ratio test were used to screen the best prediction model. The accuracy and stability of the model were evaluated through the receiver operator characteristic curve, Hosmer-lemeshow goodness of fit test and decision curve analysis, and nomograms were drawn.
RESULTS AND CONCLUSION: (1) American Society of Anesthesiologists classification, 5-factor Modified Frailty Index, ratio of C-reactive protein to albumin, preoperative hemoglobin, and age were important risk factors for serious postoperative complications of intertrochanteric fracture in the elderly. (2) The validation results of the predictive model showed that the area under the receiver operator characteristic curve of severe postoperative complications in the modeling group was 0.786, 95% confidence interval (0.722-0.850). The area under the receiver operator characteristic curve of severe postoperative complications in the validation group was 0.725, 95% confidence interval (0.640-0.808). (3) The P values of Hosmer-lemeshow goodness of fit test in modeling group and validation group were 0.738 and 0.581, respectively, which proved that the models were well calibrated. (4) Decision curve analysis showed that elderly patients with intertrochanteric fractures might benefit from clinical intervention when the threshold probabilities of the modeling group and validation group were 8%-58% and 11%-54%, respectively. (5) This study presents an effective prediction model, which is helpful to predict the occurrence of serious postoperative complications of elderly intertrochanteric fractures and help clinicians take personalized treatment measures.
Key words: Intertrochanteric fracture, aged, severe postoperative complication, risk factor, prediction model