文章摘要
腰椎术后手术部位感染的危险因素分析及列线图模型建立
Establishment of nomogram model predicting risk of surgical site infection after posterior lumbar surgery
  
DOI：10.12089/jca.2023.05.002
中文关键词: 手术部位感染  脊柱外科  危险因素  列线图  预测模型
英文关键词: Surgical site infection  Spine surgery  Risk factors  Nomogram  Predicting model
基金项目:山东省自然科学基金（ZR2016HP06）；潍坊市科学技术发展计划（医学类）（2020YX035）
作者单位E-mail
安燕 261031,山东省潍坊市,潍坊医学院附属医院麻醉科  
王慧 261031,山东省潍坊市,潍坊医学院附属医院麻醉科  
赵晓勇 潍坊医学院麻醉学院  
朱宝启 261031,山东省潍坊市,潍坊医学院附属医院脊柱外科  
郭翔 261031,山东省潍坊市,潍坊医学院附属医院脊柱外科  
姜君 261031,山东省潍坊市,潍坊医学院附属医院麻醉科 sdjiangjun@vip.qq.com 
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中文摘要:
      
目的 探讨开放性腰椎后入路手术患者术后手术部位感染（SSI）的相关危险因素，并建立与验证术后SSI的列线图风险预测模型。
方法 选择2017年1月至2021年12月行开放性腰椎后入路手术的患者920例，男422例，女498例，年龄≥18岁，BMI≥18.5 kg/m2，ASA Ⅰ—Ⅳ级。将患者按照7∶3随机分为训练数据集和验证数据集，并基于训练数据集建立预测模型。采用Lasso回归结合二元Logistic回归最终筛选的预测因素构建列线图模型。使用C指数、校准曲线及决策曲线（DCA）等对列线图模型的区分度、校准度及临床适用度进行分析评估。
结果 本研究中发生SSI的有17例（1.85%），训练集中有10例（1.55%），验证集中有7例（2.54%）。列线图模型中的预测因素包括术前低白蛋白血症（OR=36.928，95%CI 6.585～235.997，P<0.001）、肥胖（BMI≥28.0 kg/m2）（OR=4.994，95%CI 1.202～24.781，P=0.032）和术后3天内切口渗出（OR=6.133，95%CI 1.473～28.775，P=0.014）。该模型的C指数为0.879（95%CI 0.760～0.998）。校准曲线显示良好的一致性。DCA曲线分析显示当SSI发生风险阈值＞1%时，该列线图更具临床价值。
结论 术前低白蛋白血症、肥胖及术后3 d内切口渗出是行开放性腰椎后入路患者术后发生SSI的危险因素，基于以上危险因素构建的风险预测模型可以较好地预测术后SSI的发生。
英文摘要:
      
Objective To explore the risk factors of postoperative surgical site infection (SSI) in patients undergoing open lumbar posterior approach surgery, and establish and validate a column chart risk prediction model for postoperative SSI.
Methods A total of 920 patients who underwent open lumbar posterior approach surgery from January 2017 to December 2021 were selected, including 422 males and 498 females, aged ≥18 years, BMI ≥18.5 kg/m2, ASA physical status Ⅰ-Ⅳ. Patients were randomly divided into training data set and validation data set in a ratio of 7∶3. The prediction model was established based on the training data set. The nomogram model was constructed by combining Lasso regression with the predictive factors finally screened by binary logistic regression. C-index, calibration curve and decision curve (DCA) were used to analyze and evaluate the differentiation, calibration and clinical applicability of nomogram model.
Results There were 17 patients (1.85%) developed SSI, 10 patients (1.55%) in training data set, and 7 patients (2.54%) in validation data set. The predictive factors in nomogram model included preoperative hypoalbuminemia (OR = 36.928, 95% CI 6.585-235.997, P < 0.001), obesity (BMI ≥28.0 kg/m2)(OR = 4.994, 95% CI 1.202-24.781, P = 0.032) and postoperative incision exudation (OR = 6.133, 95% CI 1.473-28.775, P = 0.014). The C-index was 0.879 (95%CI 0.760-0.998). The calibration curve was in good consistency. DCA curve analysis showed that when the risk threshold of SSI is greater than 1%, the use of this nomograph in the current study was more clinically valuable.
Conclusion Preoperative hypoalbuminemia, obesity and postoperative incision exudation are risk factors for surgical site infection after open lumbar posterior approach surgery. The risk prediction model based on these risk factors can better predict the occurrence of postoperative surgical site infection.
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