| Objective:To investigate and screen the independent risk factors for postoperative delirium in elderly patients undergoing elective orthopedic surgery,to establish a prediction model and present it in a visualized form,to evaluate and validate the predictive efficiency and clinical applicability of the model,and to explore its application in predicting the risk of delirium in elderly patients undergoing elective orthopedic surgery,so as to provide an objective basis for clinicians to identify patients at high risk of postoperative delirium and to formulate reasonable prevention and treatment plans.provide an objective basis for clinicians to identify patients at high risk of postoperative delirium and develop reasonable prevention and treatment plans.Methods:Elderly patients who underwent elective orthopedic surgery at Yixing Hospital of Jiangsu University between March 2021 and May 2022 and met the criteria were selected as the modeling group,and the patient’s demographic data,laboratory test indexes,intraoperative observation indexes,and other risk factors that may be related to postoperative delirium were collected.Patients were assessed for the occurrence of delirium by two professionally trained researchers from 24 hours to 7 days postoperatively.Risk factors were initially screened using univariate analysis,and variables with statistically significant differences(P < 0.05)in univariate analysis were included in multivariate logistic regression analysis to identify independent risk factors for the occurrence of delirium in elderly patients undergoing elective orthopedic surgery,which were used to construct a column line graph prediction model,respectively,using the Receiver Operating Characteristic Curve(ROC)of the column line graph.Operating Characteristic Curve(ROC),calibration curve,and clinical decision curve were used to assess the discrimination,calibration,and clinical applicability of the model in the in-progress model group.The model was further validated internally and externally,and the internal validation was performed using the Bootstrap resampling method,with the number of samples set at 1000,and the C-index value test column line plot was used to predict the discriminatory degree of the model.The homogeneous population of Wuxi Second People’s Hospital between January 2022 and May 2022 was selected as the external validation group for spatial validation of the model,and the ROC curve,calibration curve,and clinical decision curve were used to assess the reproducibility of the model in the validation group.Results:A total of 474 patients were included in the modeling group between March 2021 and May2022,and the incidence of delirium in the modeling group was 12.2%(58/474),with a mean age of74.68 ± 8.06 years in the modeling group,including 157(33.1%)males and 317(66.9%)females.between January 2022 and May 2022.A total of 153 patients entered the external validation group,and the incidence of delirium in the validation group was 12.4%(19/153),with a mean age of 75.71± 8.32 years in the external validation group,of which 55(35.9%)were males and 98(64.1%)were females.Multifactorial logistic regression analysis showed that age(OR=6.071,P<0.001),MMSE(OR=5.324,P<0.001),sleep disorders(OR=6.159,P<0.001),serum creatinine(OR=2.148,P=0.048),ASA classification(OR=2.598,P=0.017),and neurological co-morbidity(OR=3.353,P=0.006)were six independent risk factors for postoperative delirium.In this study,the above six independent risk factors were used to construct a column line graph prediction model,which was tested to have an area under the ROC curve of 0.907(95% CI:0.873-0.941)in the model-in-progress group,a C-index of 0.895 in the internal validation of the model,and an area under the ROC curve of 0.867(95% CI:0.837-0.957).Conclusions:In this study,age ≥ 75 years,preoperative Mini-mental State Examination(MMSE)score ≤ 24,preoperative sleep disorder,neurological co-morbidity,ASA classification III-IV,and preoperative blood creatinine ≥ 75.15 umol/L were found to be six The column line graph prediction model based on the above six independent risk factors has good discrimination and calibration in predicting the risk of delirium in elderly patients undergoing elective orthopedic surgery,which can be used for clinical prediction of the probability of occurrence of postoperative delirium in elderly patients undergoing elective orthopedic surgery and assist clinicians in early identification of patients at high risk of postoperative delirium for individualized intervention,with good clinical application value. |
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