高龄髋部骨折患者术后住院时间延长危险因素分析及预测模型构建  

Risk factors analysis and prediction model construction of prolonged length of stay in oldest-old patients with hip fracture after surgery

作　　者：石昊宁 郑宏伟[2] 张晶 赵宛莹 王鸿宇 杨晓[1] 吴学谦 李京[4] Shi Haoning;Zheng Hongwei;Zhang Jing;Zhao Wanying;Wang Hongyu;Yang Xiao;Wu Xueqian;Li Jing(School of Nursing,Weifang Medical University,Weifang 261053,China)

机构地区：[1]潍坊医学院护理学院,山东潍坊261053 [2]潍坊市人民医院麻醉科 [3]济南市民族医院护理部 [4]潍坊医学院公共卫生学院

出　　处：《护理学杂志》2023年第5期20-24,共5页Journal of Nursing Science

基　　金：山东省重点研发计划项目(2019GSF111067);山东省中医药科技项目(M-2022235);潍坊市2021年科技发展计划(医学类)项目(2021YX047)。

摘　　要：目的分析高龄老年髋部骨折患者术后住院时间延长的危险因素,并构建预测模型。方法回顾性分析487例高龄髋部骨折手术治疗患者的临床资料,按7∶3的比例分为建模组(341例)和验证组(146例),确定术后住院≥8 d为术后住院时间延长,采用单因素及多因素logistic回归分析构建预测模型并予以验证。结果男性、入院距手术时间、围术期意识障碍、并存疾病数量、美国麻醉医师协会分级Ⅲ~Ⅳ为高龄老年髋部骨折患者术后住院时间延长的危险因素(均P<0.05)。利用上述危险因素构建列线图预测模型,建模组和验证组预测术后住院时间延长的曲线下面积分别为0.768和0.812;预测模型的校准曲线在两组中均表现出较好的一致性。结论男性、基本情况较差及入院距手术时间较长等是高龄老年髋部骨折患者术后住院时间延长的危险因素,该模型可为临床决策提供参考。Objective To analyze risk factors of prolonged length of stay(PLOS)in oldest-old patients with hip fracture after surge-ry,and to construct a prediction model.Methods The clinical records of 487 oldest-old patients with hip fracture after surgery were analyzed retrospectively,which were divided into a modeling group(n=341)and an validation group(n=146)according to the ratio of 7 to 3,and those patients hospitalized for 8 days or more after surgery were identified as postoperative PLOS,then the uni-variate and multivariate logistic regression analysis were conducted to construct prediction model,and its accuracy was verified.Re-sults Male sex,time interval from admission to operation,perioperative disturbance of consciousness,number of comorbidities,and ASA classificationⅢ-Ⅳwere independent risk factors of postoperative PLOS in oldest-old patients with hip fracture(all P<0.05).The nomogram prediction model was established by employing the above-mentioned risk factors.The areas under the curve(AUC)of the modeling group and the validation group for predicting postoperative PLOS were 0.768 and 0.812 respectively,and the calibration curves of the prediction model displayed a good consistency between the two groups.Conclusion Male sex,bad basic situation,and a long interval from admission to operation are risk factors of postoperative PLOS in oldest-old patients with hip fracture,the prediction model can provide a reference for clinical decision making.

关 键 词：老年人 髋部骨折 住院时间 危险因素 预测模型 动态列线图 

分 类 号：R473.6[医药卫生—护理学]