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Zhang J, Shao Y, Zhou H, Li R, Xu J, Xiao Z, Lu L, Cai L. Prediction model of deep vein thrombosis risk after lower extremity orthopedic surgery. Heliyon 2024; 10:e29517. [PMID: 38720714 PMCID: PMC11076659 DOI: 10.1016/j.heliyon.2024.e29517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Purpose This investigation was conceived to engineer and appraise a pioneering clinical nomogram, crafted to bridge the extant chasm in literature regarding the postoperative risk stratification for deep vein thrombosis (DVT) in the aftermath of lower extremity orthopedic procedures. This novel tool offers a sophisticated and discerning algorithm for risk prediction, heretofore unmet by existing methodologies. Methods In this retrospective observational study, clinical records of hospitalized patients who underwent lower extremity orthopedic surgery were collected at the Wuxi TCM Hospital Affiliated to the Nanjing University of Chinese Medicine between Jan 2017 and Oct 2019. The univariate and multivariate analysis with the backward stepwise method was applied to select features for the predictive nomogram. The performance of the nomogram was evaluated with respect to its discriminant capability, calibration ability, and clinical utility. Result A total of 5773 in-hospital patients were eligible for the study, with the incidence of deep vein thrombosis being approximately 1 % in this population. Among 31 variables included, 5 of them were identified to be the predictive features in the nomogram, including age, mean corpuscular hemoglobin concentration (MCHC), D-dimer, platelet distribution width (PDW), and thrombin time (TT). The area under the receiver operating characteristic (ROC) curve in the training and validation cohort was 85.9 % (95%CI: 79.96 %-90.04 %) and 85.7 % (95%CI: 78.96 %-90.69 %), respectively. Both the calibration curves and decision curve analysis demonstrated the overall satisfactory performance of the model. Conclusion Our groundbreaking nomogram is distinguished by its unparalleled accuracy in discriminative and calibrating functions, complemented by its tangible clinical applicability. This innovative instrument is set to empower clinicians with a robust framework for the accurate forecasting of postoperative DVT, thus facilitating the crafting of bespoke and prompt therapeutic strategies, aligning with the rigorous standards upheld by the most esteemed biomedical journals.
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Affiliation(s)
- Jiannan Zhang
- Department of Anesthesiology, Wuxi TCM Hospital, Wuxi, 214071, PR China
| | - Yang Shao
- Department of Anesthesiology, Wuxi TCM Hospital, Wuxi, 214071, PR China
| | - Hongmei Zhou
- Department of Anesthesiology, Wuxi TCM Hospital, Wuxi, 214071, PR China
| | - Ronghua Li
- Department of Anesthesiology, Wuxi TCM Hospital, Wuxi, 214071, PR China
| | - Jie Xu
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, PR China
- Université de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Zhongzhou Xiao
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, PR China
| | - Lu Lu
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, PR China
| | - Liangyu Cai
- Department of Anesthesiology, Wuxi TCM Hospital, Wuxi, 214071, PR China
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Shi LT, Kong FQ. Evaluation of preoperative coagulation function changes and deep vein thrombosis incidence in elderly patients with hip fractures. Clin Hemorheol Microcirc 2024:CH242122. [PMID: 38517782 DOI: 10.3233/ch-242122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This study involved an analysis of preoperative deep vein thrombosis (DVT) incidence and changes in coagulation function among elderly patients suffering from hip fractures. The objective was to offer guidance on the prevention and management of preoperative DVT in the lower extremities of elderly individuals with hip fractures. METHODS A total of 282 elderly individuals with a hip fracture were enrolled and divided into two groups based on the location of the fracture: femoral intertrochanteric fracture (FIF, 161 individuals) and femoral neck fracture (FNF, 121 individuals). The two groups were compared with respect to baseline characteristics, including gender, age, and comorbid chronic diseases. Furthermore, the analysis encompassed the incidence of preoperative DVT in both lower extremities, along with seven coagulation parameters and platelet count before the surgical procedure. RESULTS There was no significant difference in baseline information between the two groups. The incidence of preoperative DVT in the FIF group was higher than that in the FNF group, along with a significantly higher percentage of patients exhibiting increased levels of D-dimer and fibrinogen/fibrin degradation products (FDPs). CONCLUSION Preoperative hypercoagulability and a greater prevalence of DVT were observed in elderly individuals with FIF compared to individuals with FNF. This indicates that clinicians should pay attention to elderly patients with FIFs, especially those with increased D-dimer and FDP levels.
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Affiliation(s)
- Li-Tao Shi
- Trauma Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Fan-Qiang Kong
- Department of Medical Imaging, The Affiliated Hospital of Chengde Medical University, Chengde, China
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Zhang Y, Ma Y, Wang J, Guan Q, Yu B. Construction and validation of a clinical prediction model for deep vein thrombosis in patients with digestive system tumors based on a machine learning. Am J Cancer Res 2024; 14:155-168. [PMID: 38323284 PMCID: PMC10839316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
This study developed a deep vein thrombosis (DVT) risk prediction model based on multiple machine learning methods for patients with digestive system tumors undergoing surgical treatment. Data of 1048 patients with digestive system tumors admitted to Shanxi Provincial People's Hospital (College of Shanxi Medical University) from January 2020 to January 2023 were retrospectively analyzed, and 845 cases were screened according to the inclusion and exclusion criteria. The patients were divided into a training group (586 patients), and a validation group (259 patients), then feature selection was performed using six models, including Lasso regression, XGBoost, Random Forest, Decision Tree, Support Vector Machine, and Logistics. Predictive models were subsequently constructed from column-line plots, and the predictive validity of the models was assessed using receiver operating characteristic curves, precision-recall curves, and decision-curve analysis. In the model comparison, the XGBoost model showed the largest area under the curve (AUC) on the validation set (P < 0.05), demonstrating excellent predictive performance and generalization ability. We selected the common characteristic factors in the six models to further develop the column line plots to assess the DVT risk. The model performed well in clinical validation and effectively differentiated high-risk and low-risk patients. The differences in BMI, procedure time, and D-dimer were statistically significant between patients in the thrombus group and those in the non-thrombus group (P < 0.05). However, the AUC of the Xgboost model was found to be greater than that of the column chart model by the Delong test (P < 0.05). BMI, procedure time, and D-dimer are critical predictors of DVT risk in patients with digestive system tumors. Our model is an adequate assessment tool for DVT risk, which can help improve the prevention and treatment of DVT.
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Affiliation(s)
- Yunfeng Zhang
- Department of Vascular Surgery, Shanxi Provincial People’s Hospital (The Fifth Clinical Medical School of Shanxi Medical University)No. 29 Shuangtasi Street, Taiyuan 030012, Shanxi, China
| | - Yongqi Ma
- Shanxi University of Chinese MedicineNo. 121 Daxue Street, Yuci District, Jinzhong 030619, Shanxi, China
| | - Jie Wang
- Department of Vascular Surgery, Shanxi Provincial People’s Hospital (The Fifth Clinical Medical School of Shanxi Medical University)No. 29 Shuangtasi Street, Taiyuan 030012, Shanxi, China
| | - Qiang Guan
- Department of Vascular Surgery, Shanxi Provincial People’s Hospital (The Fifth Clinical Medical School of Shanxi Medical University)No. 29 Shuangtasi Street, Taiyuan 030012, Shanxi, China
| | - Bo Yu
- Department of Operating Room, Affiliated Hospital of Hebei UniversityNo. 212 Yuhua East Road, Lianchi District, Baoding 071000, Hebei, China
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Zhang H, Wu F, Sun J, Liu Y, Zhou Z, Wu X, Liang B. The impact of frailty evaluation on the risk of venous thromboembolism in patients with hip fracture following surgery: a meta-analysis. Aging Clin Exp Res 2023; 35:2413-2423. [PMID: 37707745 DOI: 10.1007/s40520-023-02529-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Frailty has been associated with a higher incidence of overall postoperative complications and mortality. However, the influence of frailty on the risk of venous thromboembolism (VTE) in patients with hip fracture following surgery remains unclear. We performed a meta-analysis to systematically evaluate the above association. METHODS PubMed, Embase, Cochrane Library, Wanfang and CNKI were searched for relevant observational studies comparing the incidence of postoperative VTE in patients of hip fracture with and without frailty. Data collection, literature searching, and statistical analysis were conducted independently by two authors. Using a heterogeneity-incorporating random-effects model, the results were pooled. RESULTS In this meta-analysis, 9509 patients from nine cohort studies were included. Pooled results showed that compared to those without frailty, patients with frailty at admission had a higher incidence of postoperative VTE (odds ratio [OR]: 2.59, 95% confidence interval [CI]: 1.25-5.39, p = 0.01; I2 = 66%). Subgroup analysis suggested the association between frailty and postoperative VTE was more remarkable in studies of patients with frailty prevalence < 50% (OR 6.28, 95% CI 3.31-11.90, p < 0.001; I2 = 8%) as compared to those ≥ 50% (OR 1.30, 95% CI 0.80-2.11, p = 0.28; I2 = 0%; p for subgroup difference < 0.001). Further meta-analyses showed that frailty at baseline was associated with a higher incidence of deep venous thrombosis (OR 3.15, 95% CI 1.33-7.47, p = 0.009; I2 = 59%), but not pulmonary embolism (OR 1.13, 95% CI 0.59-2.16, p = 0.72; I2 = 0%). CONCLUSION Frailty is associated with a higher incidence of postoperative VTE in patients with hip fracture.
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Affiliation(s)
- Haixia Zhang
- Department of Anesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Fang Wu
- Department of Anesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Jianbin Sun
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yongchao Liu
- Department of Anesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Zifu Zhou
- Burn and Plastic Surgery Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Xuejun Wu
- Burn and Plastic Surgery Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Bin Liang
- Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, No. 301, Zhengyuan Beijie, Jinfeng District, Yinchuan, 750004, China.
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Guo H, Wang T, Li C, Yu J, Zhu R, Wang M, Zhu Y, Wang J. Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4724-4734. [PMID: 37378681 DOI: 10.1007/s00167-023-07488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE This study aimed to identify independent risk factors for immediate postoperative deep vein thrombosis (DVT) in patients with open wedge high tibial osteotomy (OWHTO) and to develop and validate a predictive nomogram. METHODS Patients who underwent OWHTO for knee osteoarthritis (KOA) from June 2017 to December 2021 were retrospectively analyzed. Baseline data and laboratory test results were collected, and the occurrence of DVT in the immediate postoperative period was regarded as the study outcome event. Multivariable logistic regression identified independent risk factors associated with a higher incidence of immediate postoperative DVT. The predictive nomogram was constructed based on the analysis results. The stability of the model was further assessed in this study using patients from January to September 2022 as an external validation set. RESULTS 741 patients were enrolled in the study, of which 547 were used in the training cohort and the other 194 for the validation cohort. Multivariate analysis revealed a higher Kellgren-Lawrence (K-L) grade (III vs. I-II OR 3.09, 95% CI 0.93-10.23. IV vs. I-II OR 5.23, 95% CI 1.27-21.48.), platelet to hemoglobin ratio (PHR) > 2.25 (OR 6.10, 95% CI 2.43-15.33), Low levels of albumin (ALB) (OR 0.79, 95% CI 0.70-0.90), LDL-C > 3.40 (OR 3.06, 95% CI 1.22-7.65), D-dimer > 1.26 (OR 2.83, 95% CI 1.16-6.87) and BMI ≥ 28 (OR 2.57, 95% CI 1.02-6.50) were the independent risk factors of immediate postoperative DVT. The concordance index (C-index) and Brier score of the nomogram were 0.832 and 0.036 in the training set, and the corrected values after internal validation were 0.795 and 0.038, respectively. The receiver-operating characteristic (ROC) curve, the calibration curve, the Hosmer-Lemeshow test, and the decision curve analysis (DCA) performed well in both the training and validation cohorts. CONCLUSION This study developed a personalized predictive nomogram with six predictors, which allows surgeons to stratify risk and recommended immediate ultrasound scans for patients with any of these factors. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Haichuan Guo
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Tianyu Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Chengsi Li
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Jiahao Yu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Ruoxuan Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Maolin Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Juan Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Wu YL, Zhang D, Zhang KY, Yan T, Qiang WS, Zhang T, Zhang BF. The association between admission serum albumin and preoperative deep venous thrombosis in geriatrics hip fracture: a retrospective study of 1819 patients with age ≥ 65 years. BMC Musculoskelet Disord 2023; 24:672. [PMID: 37620804 PMCID: PMC10464240 DOI: 10.1186/s12891-023-06776-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE This study evaluated the association between serum albumin levels and preoperative deep vein thrombosis (DVT) in geriatric hip fractures. METHODS Older adult patients with hip fractures were screened between January 2015 and September 2019. The demographic and clinical characteristics of the patients were collected. Multivariate binary logistic regression and generalized additive model were used to identify the linear and nonlinear association between albumin levels and preoperative DVT. Analyses were performed using EmpowerStats and the R software. RESULTS A total of 1819 patients were included in this study. The average age was 79.37 ± 6.88 years. There were 550 males and 1269 females. The preoperative albumin was 38.19 ± 4.07 g/L. There were 580 (31.89%) preoperative DVTs. Multivariate binary logistic regression showed that albumin level was associated with preoperative DVT (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.91-0.97, P = 0.0002) after adjusting for confounding factors. The fully adjusted model showed a DVT risk decrease of 6% when albumin concentration increased by one g/L after controlling for confounding factors. In addition, the trend test and propensity score matching also showed a stable linear correlation between albumin level and preoperative DVT. CONCLUSION Serum albumin is associated with preoperative DVT in geriatric patients with hip fractures, and it could be considered a predictor for the risk of DVT. REGISTRATION ID ChiCTR2200057323.
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Affiliation(s)
- Yi-Lun Wu
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Dan Zhang
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Kai-Yuan Zhang
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Ting Yan
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Wen-Si Qiang
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Ting Zhang
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710054, Shaanxi Province, China.
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Jin L, Dong L, Zhu Y, Li X, Hou Z, Zhang Y. Elderly hip fracture patients with isolated calf muscle vein thrombosis are more likely to have suffered an intertrochanteric fracture and be hypertensive. J Orthop Surg Res 2023; 18:540. [PMID: 37507789 PMCID: PMC10385920 DOI: 10.1186/s13018-023-04043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE This study aimed to characterize the preoperative deep venous thrombosis (DVT) of lower extremity by locations and evaluate the diagnostic ability of plasma D-dimer level in elderly patients with hip fracture. METHOD This retrospective study reviewed the elderly patients presenting with a hip fracture definitely undergoing surgical treatment and identified those who had preoperative DVT. Data on demographics, lifestyle habits, comorbidities and laboratory indexes were extracted and collected. Four groups were divided by presence and locations of thrombi: non-DVT (controls), isolated calf muscle vein thrombosis (CMVT), deep calf vein thrombosis (DCVT) and proximal DVT group. The comparisons were conducted between either DVT group or the non-DVT group. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used for determining the diagnostic ability of D-dimer for each group. RESULTS Among 951 eligible patients included, 298 (31.3%) were found have preoperative DVT. Compared to non-DVT group, patients with CMVT had significantly lower albumin and hemoglobin concentration, more likely an intertrochanteric fracture and a higher prevalence of hypertension (P = 0.001, 0.006, 0.002 and 0.024, respectively); DCVT group was not observed to be significantly different in terms of any variables (all P > 0.05); and proximal DVT group had older age and more patients ≥ 80 years, lower albumin and hemoglobin concentration, higher prevalence of hypertension, more likely an intertrochanteric fracture, extended time from injury to imaging examination and higher age-adjusted Charlson comorbidity index (ACCI) (all P < 0.05). D-dimer demonstrated nonsignificant diagnostic ability for CMVT and DCVT, and a significant but poor ability for proximal DVT (AUC, 0.621; 95% CI 0.542-0.710; P = 0.011). CONCLUSION Varying characteristics were found among preoperative DVT stratified by locations after elderly hip fractures, and D-dimer level demonstrated no or poor diagnostic ability for DVTs by locations. Level of evidence level III, diagnostic. Trial registration statement Not applicable.
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Affiliation(s)
- Lin Jin
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Hebei Institute of Orthopaedic Biomaterials and Technological Innovation, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Lei Dong
- Department of Orthopaedic Surgery, Huai'an Hospital of Huai'an City, Huai'an, 223200, Jiangsu, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
- Hebei Institute of Orthopaedic Biomaterials and Technological Innovation, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiuting Li
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopaedic Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Hebei Institute of Orthopaedic Biomaterials and Technological Innovation, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopaedic Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Hebei Institute of Orthopaedic Biomaterials and Technological Innovation, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Han S, Bai Y, Jiao K, Qiu Y, Ding J, Zhang J, Hu J, Song H, Wang J, Li S, Feng D, Wang J, Li K. Development and validation of a newly developed nomogram for predicting the risk of deep vein thrombosis after surgery for lower limb fractures in elderly patients. Front Surg 2023; 10:1095505. [PMID: 37273830 PMCID: PMC10232847 DOI: 10.3389/fsurg.2023.1095505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/13/2023] [Indexed: 06/06/2023] Open
Abstract
Background Prevention of deep vein thrombosis (DVT) is indispensable in the treatment of lower limb fractures during the perioperative period. This study aimed to develop and validate a novel model for predicting the risk of DVT in elderly patients after orthopedic surgeries for lower limb fractures. Methods This observational study included 576 elderly patients with lower limb fractures who were surgically treated from January 2016 to December 2018. Eleven items affecting DVT were optimized by least absolute shrinkage and selection operator regression analysis. Multivariable logistic regression analysis was performed to construct a predictive model incorporating the selected features. C-index was applied to evaluate the discrimination. Decision curve analysis was employed to determine the clinical effectiveness of this model and calibration plot was applied to evaluate the calibration of this nomogram. The internal validation of this model was assessed by bootstrapping validation. Results Predictive factors that affected the rate of DVT in this model included smoking, time from injury to surgery, operation time, blood transfusion, hip replacement arthroplasty, and D-dimer level after operation. The nomogram showed significant discrimination with a C-index of 0.919 (95% confidence interval: 0.893-0.946) and good calibration. Acceptable C-index value could still be reached in the interval validation. Decision curve analysis indicated that the DVT risk nomogram was useful within all possibility threshold. Conclusion This newly developed nomogram could be used to predict the risk of DVT in elderly patients with lower limb fractures during the perioperative period.
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Affiliation(s)
- Shuai Han
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Yunpeng Bai
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Kun Jiao
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Yongmin Qiu
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Juhong Ding
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Jun Zhang
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Jingyun Hu
- Department of Orthopedics, The Second Hospital of Dalian Medical University, Dalian, China
| | - Haihan Song
- Department of Orthopedics, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jiaqi Wang
- Central Lab, Shanghai Key Laboratory of Pathogenic Fungi Medical Testing, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Shufeng Li
- Department of Orthopedic Surgery, ShandongKey Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Dapeng Feng
- Central Lab, Shanghai Key Laboratory of Pathogenic Fungi Medical Testing, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Jian Wang
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Kai Li
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
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Wang Y, Liang X, Wang S, Wang Y, Qin L, Chen D, Jiang Y, Zhang H. Analysis of the Risk Factors for Elevated D-Dimer Level After Breast Cancer Surgery: A Multicenter Study Based on Nursing Follow-Up Data. Front Oncol 2022; 12:772726. [PMID: 35928882 PMCID: PMC9343692 DOI: 10.3389/fonc.2022.772726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
D-dimer level is often used to assess the severity of trauma as well as the risk of thrombosis. This study investigated the risk factors for high postoperative D-dimer level. This study included a total of 2706 patients undergoing breast cancer surgery to examine the associations between various clinicopathological factors and variation in D-dimer levels. After adjusting for other factors, T stage, neoadjuvant chemotherapy, blood loss, surgery type, diabetes, and elevated leukocyte and neutrophil counts were found to be significant risk factors for D-dimer variation. This study identified several factors associated with elevated D-dimer levels and consequent thrombosis after breast cancer surgery, which may aid in the development of more precise preventive measures and interventions as well as serve as a reference for future research.
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Affiliation(s)
- Yanqiu Wang
- Department of Breast Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Xi Liang
- Department of Breast Surgery, Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
| | - Shujun Wang
- Department of Obstetrics and Gynecology, Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
| | - Yuying Wang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
| | - Ling Qin
- Department of Operation Room, Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
| | - Danni Chen
- Department of Neurology, Boao Yiling Life Care Center, Boao, China
| | - Yanlin Jiang
- Department of Breast Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Hao Zhang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
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