摘要
目的探讨美国外科医师协会在线手术风险（American College of Surgeons NationalSurgical Quality Improvement Program,ACS NSQIP）评估计算器在老年人工股骨头置换术后并发症评估中的有效性。方法通过回顾2013年至2016年我院骨科345例股骨头置换术，年龄〉60岁患者，收集每个患者21个相关参数（年龄、性别、功能状态等）分别带人ACSNSQIP手术风险评估计算器，得出并发症的预测值，利用ROC曲线与实际并发症进行对比分析。采用Pearson相关系数研究比较严重并发症与21个参数之间的相关性，以及不同并发症之间的相关性。结果在人工股骨头置换术的12项并发症（包括死亡、泌尿系感染、静脉血栓、心血管事件、肾衰竭、肺炎、手术部位感染、任何并发症、严重并发症、再住院率、二次手术、术后护理与康复）中，ACSNSQIP手术风险评估计算器预测术后并发症的AUC值，除了预测手术部位感染（AUC=0．47）以外，其他并发症预测的AuC值均〉0．5，术后护理与康复相关性较高（AUC=0．62）；预测值中严重并发症与21个参数之间存在较高的相关性（P〈0．05）；常见并发症中心血管事件与肺炎的发生显著相关（Pearson相关系数为0．91，置信区间：[0．86-0．94]（P〈2．2E-16）。结论ACSNSQIP计算器对预测人工股骨头置换术后的并发症具有一定的有效性。
Objective To evaluate the effectiveness of American College of Surgeons （ACS） National Surgical Quality Improvement Program（NSQIP）surgical risk calculator in the evaluation of postoperative complications of elderly patients undergoing prosthetic femoral head replacement. Methods Three hundred and forty-five elderly patients（〉60 years）who had underdone femoral head replacement from January 2013 to December 2015 were recruited. Data on twenty-one parameters（age, sex,functional status, etc. ）were collected for the ACS NSQIP surgical risk calculator and predictive values for complications were also obtained. The ROC curve was compared with the actual complication. The Pearson correlation coefficient was used to analyze the correlation between serious complications and the 21 parameters, and the correlation between different complications. Results There were 12 complications, including death, urinary tract infection, venous thrombosis, cardiovascular events, renal failure, pneumonia, surgical site infection, any complication, serious complications, readmission,return to OR,and discharge to nursing or rehab facilities. The ACS NSQIP surgical risk assessment calculator was able to predict postoperative complications（AUC〉0.5, except surgical site infection, for which AUC=0.47）. The predictive value for discharge to nursing or rehab facilities was the highest（AUC= 0.62）. Moreover,there was a significant correlation between complications and the 21 parameters（P〈0.05）. Cardiovascular events were significantly associated with the occurrence of pneumonia in common complications （ Person correlation coefficient~ 0.91,95 %CI：0.86 - 0.94, P〈 0.05）. Conclusions The ACS NSQIP calculator is effective in predicting postoperative complications inelder patients with prosthetic femoral head replacement.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2017年第11期1216-1219,共4页
Chinese Journal of Geriatrics
关键词
股骨头坏死
危险性评估
Femur head necrosis
Risk assessment
