Analysis Of Related Factors And Establishment Of Prediction Model For Complications After Total Hip Replacement In Elderly Patients

Objective:By reviewing the occurrence of complications after total hip replacement in elderly patients(≥75岁),the related factors of complications were analyzed,and the prediction model of postoperative complications was established.Methods:Clinical data of 308 elderly patients(≥75 years old)who underwent total hip replacement in our hospital from January 2013 to September 2022 were collected according to the inclusion and exclusion criteria.Postoperative complications were recorded,including pulmonary complications(lung infection,pleural effusion,atractasis,respiratory failure),cardiovascular complications(acute myocardial infarction,new arrhythmia,heart failure,sudden cardiac death),neurological complications(postoperative delirium,new or recurrent cerebral infarction),acute kidney injury,and new lower limb venous thrombosis.According to the postoperative complications,they were divided into total complications group(80cases)and no complications group(228 cases),and according to the postoperative complications,they were divided into cardiopulmonary complications group(57 cases)and no cardiopulmonary complications group(251 cases).For the factors of collection,They included sex,age,American Society of Anesthesiologists(ASA)rating,body mass index(BMI),history of hypertension,diabetes,coronary heart disease,cerebral infarction,albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),serum creatinine(SCr),and activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),thrombin time(TT),blood potassium,glucose(Glu),white blood cells(WBC),hemoglobin(HGB),platelet(PLT),pulmonary artery pressure,arrhythmia status,diagnosis,surgical method,Operative waiting time,anesthesia method,intraoperative blood loss,operation duration,and intraoperative blood transfusion were firstly analyzed by univariate analysis to find out the factors with statistical differences,and then the factors with statistical differences were analyzed by binary Logistic regression to determine the independent risk factors or protective factors of total complications and cardiopulmonary complications after total hip replacement in elderly patients.The prediction models of total complications and cardiopulmonary complications were established according to the results of binary Logistic regression.Hosmerand Lemeshow test was used to verify the goodness of fit of the two models,and receiver operating characteristic curve(ROC)was drawn to evaluate the prediction value of the two models.Results:1.A total of 308 patients were included in this study,of which 80 had postoperative complications and 228 had no complications.Pulmonary complications occurred in 51 cases(16.5%),including pulmonary infection,pleural effusion,atelectasis in 43 cases,respiratory failure in 4 cases,respiratory failure death in 4cases;There were 15 cases(4.8%)of cardiovascular complications,including 9 cases of arrhythmia,4 cases of heart failure and 2 cases of sudden cardiac death.There were23 cases(7.4%)of neurological complications,including 2 new cerebral infarction and 21 delirium.Postoperative thrombosis of lower extremity vein occurred in 2patients(0.6%);Acute kidney injury occurred in 13 cases(4.2%).Among the 80patients with complications,61 had one complication,14 had two complications,and5 had three complications.2.In the total postoperative complications,univariate analysis showed that age(P<0.001),ASA classification(P<0.001),ALB(P<0.001),HGB(P<0.05)and intraoperative blood loss(P<0.001)were significantly different between the two groups.After binary Logistic stepwise regression analysis,Age(OR=1.078,95%CI1.013-1.146,P<0.05),ASA classification(OR=3.509,95%CI 2.083-5.910,P<0.001),intraoperative blood loss(OR=1.005,95%CI 1.003-1.008,P<0.001)was an independent risk factor for total postoperative complications,and ALB(OR=0.891,95%CI 0.826-0.960,P<0.05)was a protective factor for total postoperative complications.According to the results of binary Logistic regression,the regression prediction model Logit(P)=-7.712+0.075×years of age+1.255×ASA classification(GradeⅡ=2,gradeⅢ=3,gradeⅣ=4)+0.005×intraoperative blood loss(ml)-0.116×ALB(g/L)was constructed.The Hosmer and Lemeshow test,c~2=9.382,P=0.311(P>0.05),the model fitting is good.The calculated area under ROC curve is0.795[95%CI(0.740-0.850)],P<0.001,indicating that this model has good predictive value.When the Yoden index of ROC curve was 0.483,the predicted value of the model was 0.249,the sensitivity was 0.738,and the specificity was 0.746.3.In postoperative cardiopulmonary complications,Univariate analysis showed that age(P<0.001),ASA classification(P<0.001),ALB(P<0.05),diabetes(P<0.05),coronary heart disease(P<0.05),HGB(P<0.05)and intraoperative blood loss(P<0.001)were statistically significant differences between the two groups.After binary Logistic step by step regression analysis,Age(OR=0.08,95%CI1.014-1.157,P<0.05),ASA classification(OR=1.367,95%CI 2.170-7.100,P<0.001),intraoperative blood loss(OR=1.006,95%CI1.003-1.009,P<0.001)was an independent risk factor for postoperative cardiopulmonary complications,and HGB(OR=0.978,95%CI 0.961-0.996,P<0.05)was a protective factor for postoperative cardiopulmonary complications.According to the results of binary Logistic regression,the regression prediction model Logit(P)=-10.498+0.08×age(years)+1.367×ASA classification(GradeⅡ=2,gradeⅢ=3,gradeⅣ=4)+0.006×intraoperative blood loss(ml)-0.022×HGB(g/L)was constructed.The Hosmer and Lemeshow test,c~2=4.501,P=0.809(P>0.05),the model fitting is good.Through calculation,the product under ROC curve was 0.807[95%CI(0.745-0.870)],P<0.001,indicating that this model has good predictive value.When the Yoden index of ROC curve was 0.478,the predicted value of the model was 0.169,the sensitivity was 0.737,and the specificity was 0.741.Conclusion(s):1.The highest incidence of complications after total hip replacement in elderly patients is pulmonary complications,which are the main cause of death in this study.2.Age,ASA grade and intraoperative blood loss are independent risk factors for total complications and cardiopulmonary complications after total hip replacement in elderly patients,preoperative albumin level is a protective factor for total complications after total hip replacement.Preoperative hemoglobin level is a protective factor for postoperative cardiopulmonary complications.3.The regression prediction model established in this study can better predict the occurrence of total complications and cardiopulmonary complications in elderly patients after total hip replacement respectively.