Analysis Of Risk Factors And Construction And Evaluation Of A Predictive Model Of Postoperative Complications Of Posterior Lumbar Interbody Fusion In Middle-Aged And Elderly Patients

[Background]With the development of modern medicine and improvements in social conditions,the expected lifespan has been extended.As a result,an increasing number of middle-aged and elderly patients suffer from the pain of degenerative lumbar disease.As a country with a large population,China’s incidence of degenerative spinal diseases is increasing year by year due to population aging and changes in lifestyle.The prevalence of this disease has become a serious public health problem affecting the health and quality of life of middle-aged and elderly people.For a long time,decompression of the vertebral canal and reconstruction of spinal stability through interbody fusion has been regarded as the best surgical method for treating degenerative lumbar disease.The main advantage of PLIF surgery is that it allows the surgeon to obtain a better view and a more direct surgical approach,and the learning curve is short,thus achieving better surgical outcomes.However,with the widespread adoption of PLIF,there has also been an increase in postoperative complications.Postoperative complications are the main reason affecting patient recovery and unplanned reoperation,which is enough to draw our attention to the in-depth study of complications in spinal surgery.[Object]This study comprehensively analyzed its related risk factors and established a corresponding nomogram prediction model.This prediction model can quantitatively assess the risk of postoperative complications based on the individual situation of the patient,and provide corresponding prevention and management suggestions,in order to provide reference for clinical physicians in the perioperative management,reduce the incidence of complications of traditional open PLIF surgery,and improve the quality and safety of surgical treatment.[Methods]We retrospectively collected medical records of middle-aged and elderly patients who underwent traditional open PLIF surgery in our hospital from January 2017 to December 2021 and divided them into modeling and validation groups.After verifying the results of the univariate logistic regression analysis,we obtained the risk factors for postoperative complications of PLIF surgery.For the risk factors with P<0.05 in the univariate logistic regression analysis,we conducted a multivariate unconditional logistic regression analysis and obtained the corresponding independent risk factors.Then,based on the results of the multivariate logistic regression analysis,we selected the relevant independent risk factors and established a nomogram prediction model,which was evaluated by calibration curve,clinical decision analysis(DCA)curve,and receiver operating characteristic(ROC)curve.[Results]This study included a total of 575 patients,of which 68 had postoperativecomplications,resulting in a 11.8%incidence rate.Results from both single-factor analysis and multivariable logistic regression analysis showed that BMI≥24kg/m~2(OR=16.7),hypertension(OR=4.598),diabetes(OR=6.467),disease duration≥5years(OR=4.071),fused segments≥3(OR=4.271),operation time≥180min(OR=3.216),and intraoperative blood loss ≥500ml(OR=3.501)were independent risk factors for postoperative complications after PLIF(P<0.05).The area under the curve(AUC)values of the ROC curves for the modeling and validation groups of the nomogram prediction model(Figure 2)、were 0.932 and 0.909,respectively(Figure 3),indicating good discriminative ability of the model.The DCA curves of the two groups(Figure5)showed that the model curve was far from the All and None lines in the range of diagnostic threshold of 0.1-0.8,indicating that the use of this nomogram can obtain high clinical application value in a larger range of diagnostic thresholds.In the calibration curves of the two groups(Figure 4),it can be observed that the model curves were highly consistent with the standard curves,both in the modeling group and the validation group,indicating that the model prediction risk was consistent with the actual risk and the model accuracy was high.The above results indicate that the prediction ability of the model is reliable,and the objectivity and accuracy of the nomogram model are good,which can show good discriminative ability in clinical practice.[Conclusions]The patients’ BMI≥24kg/m~2,hypertension,diabetes,disease course≥ 5years,fused segments≥3,operation time≥180min,and intraoperative blood loss≥ 500ml are independent risk factors of postoperative complications after PLIF.The nomgram prediction model established in this study has excellent performance and can effectively assist clinicians in early identification of high-risk patients with postoperative complications and provide important reference for clinical doctors.