| Objective:To explore the independent risk factors that influence the postoperative hypercoagulability status of patients undergoing total knee arthroplasty(TKA),and then develop a predictive model for predicting postoperative hypercoagulability status of TKA patients,in order to allow clinical joint surgeons to make predictions on patients whose coagulation status is hypercoagulable after TKA,to reduce or avoid the development of venous thromboembolism(VTE)due to postoperative hypercoagulability.Methods:This study prospectively collected data from 136 patients diagnosed with knee osteoarthritis(KOA)who underwent TKA and met the inclusion criteria at the Joint Surgery Department of the Affiliated Hospital of Qingdao University from May 2019 to January2020.Including the patient’s age,gender,anesthesia method,unilateral and bilateral,history of hypertension,history of diabetes,history of smoking,history of drinking,history of diabetes and other clinical data.According to the results of the thrombelastography(TEG)coagulation index of the patients on the fifth day after the operation,the patients after TKA were divided into hypercoagulable group and non-hypercoagulable group.The data of the two groups of patients were statistically analyzed with SPSS 25 software(IBM,USA),and the measurement data were tested for normality.Measurement data that satisfies the normal distribution were described in the form of mean ± standard deviation,and comparison between groups was used Independent sample t test,signed rank sum test was used for the comparison of non-normally distributed measurement data between groups.Chi-square test was used for counting data.Through univariate analysis,find out statistically significant differences between the two groups of patients.The data with statistically significant differences in the univariate analysis were included in the multivariate logistic regression analysis to determine the factors independently related to the postoperative hypercoagulability status of TKA patients.Use R software(version 4.0.2)to develop a nomogram prediction model of hypercoagulable state after TKA in KOA patients,and use receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis method(DCA)to evaluate the discrimination and accuracy of the nomogram model.Results:All patients successfully completed the operation,and no patients had fatal complications such as myocardial infarction or pulmonary embolism.Among the 136 patients,29 patients had postoperative hypercoagulability,accounting for 21.3%.4 patients had lower extremity venous thrombosis.All patients had asymptomatic intermuscular venous thrombosis and all patients had postoperative hypercoagulability.Multivariate analysis showed that operation time and age were independent risk factors for hypercoagulability after TKA in KOA patients.Using these two independent risk factors,we successfully developed a predictive model for predicting hypercoagulability in KOA patients after TKA.The area under the curve of the evaluation nomogram is 0.757,and the calibration curve and DCA results show that the nomogram has excellent calibration and clinical application value.Conclusion:The nomogram model constructed based on the patient’s age and operation time to predict the hypercoagulable state of patients after TKA has good accuracy,it can provide guidance for clinical joint surgeons to predict the hypercoagulable state in advance,achieving targeted and focused prevention.Clinical joint surgeons should attach great importance to elderly KOA patients undergoing TKA.At the same time,clinical joint surgeons should be proficient in the basic principles and techniques of TKA and make adequate and targeted preoperative preparations for each patient who will undergo TKA.On the premise of guaranteeing high-quality operation for KOA patients,the operation time should be shortened as much as possible. |
PDF Full Text Request