Preoperative Risk Factor Analysis and Dynamic Online Nomogram Development for Early Infections Following Primary Hip Arthroplasty in Geriatric Patients with Hip Fracture

Abstract

Background

Hip arthroplasty is in increasing demand with the aging of the world population, and early infections, such as pneumonia, surgical site infection (SSI), and urinary tract infection (UTI), are uncommon but fatal complications following hip arthroplasty. This study aimed to identify preoperative risk factors independently associated with early infections following primary arthroplasty in geriatric hip fracture patients, and to develop a prediction nomogram.

Methods

Univariate and multivariate logistical analyses were performed to identify the independent risk factors for early infections, which were combined and transformed into a nomogram model. The prediction model was evaluated by using the area under the receiver operating characteristic curve (AUC), Hosmer–Lemeshow test, concordance index (C-index), 1000 bootstrap replications, decision curve analysis (DCA), and calibration curve.

Results

One thousand eighty-four eligible patients got included and 7 preoperative variables were identified to be independently associated with early infections, including heart disease (odds ratio (OR): 2.17; P: 0.026), cerebrovascular disease (OR: 2.25; P: 0.019), liver disease (OR: 8.99; P: <0.001), time to surgery (OR: 1.10; P: 0.012), hematocrit (<lower limit; OR: 3.72; P: 0.015), the platelet-to-mean platelet volume ratio (PMR; >44.52; OR: 2.73; P: 0.047), and high-sensitivity C-reactive protein (HCRP; >78.64mg/L; OR: 3.71; P: <0.001). For the nomogram model, AUC was 0.807 (95% confidence interval (CI): 0.742–0.873), the Hosmer-Lemeshow test demonstrated no overfitting (P = 0.522), and C-index was 0.807 (95% CI: 0.742–0.872) with corrected value of 0.784 after 1000 bootstrapping validations. Moreover, the calibration curve and DCA exhibited the tools’ good prediction consistency and clinical practicability.

Conclusion

Heart disease, cerebrovascular disease, liver disease, time to surgery, hematocrit, PMR, and HCRP were significant preoperative predictors for early infections following primary arthroplasty in elderly hip fracture patients, and the converted nomogram model had strong discriminatory ability and translatability to clinical application.

Keywords:

• early infections
• arthroplasty
• hip fracture
• geriatric
• nomogram

Abbreviations

SSI, surgical site infection; UTI, urinary tract infection; DCA, decision curve analysis; C-index, concordance index; OR, odds ratio; PJI, periprosthetic joint infection; THA, total hip arthroplasty; ROC, receiver operating characteristic; AUC, the area under the curve; SSIOS, Surgical Site Infection in Orthopaedic Surgery; STROCSS, Strengthening the Reporting of Cohort Studies in Surgery; BMI: Body mass index; ASA, American Society of Anesthesiologists; RBC, red blood cell, reference range: Female, 3.5–5.0×1012/L; males, 4.0–5.5×1012/L; HCT, hematocrit, reference range: Females, 35–45%; males, 40–50%; HGB, hemoglobin, reference range: Females, 110–150g/L; males, 120–160g/L; PLT, platelet; MPV, mean platelet volume; PMR, the platelet to mean platelet volume ratio; WBC, white blood cell; NEU, neutrophil; LYM, lymphocyte; NLR, the neutrophil-to-lymphocyte ratio; TP, total protein; ALB, albumin; FBG, fasting blood glucose; HCRP, high-sensitivity C-reactive protein; CT, computed tomography; SIRS, systemic inflammatory response syndrome; HCV, hepatitis C virus.

Data Sharing Statement

All the data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

This study was approved by the ethics committee of the 3rd Hospital of Hebei Medical University and the informed consent was waived for its retrospective nature. All the data were analyzed anonymously to safeguard patient privacy.

Consent for Publication

We have obtained the consent for publication from all participants.

Acknowledgments

The Key Laboratory of Biomechanics of Hebei Province provided the site for querying data.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

The authors have received no external funding in order to support this project.