Xu Nafei, Xu Taotao, Tan Xiaoxue, Xu Lujie, Ye Menghua, Pan Yue, Tong Peijian, Hu Xueqin, Xu Min
School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Health and Tourism, Hangzhou Wanxiang Polytechnic, Hangzhou, China.
Front Surg. 2021 Sep 17;8:690803. doi: 10.3389/fsurg.2021.690803. eCollection 2021.
In the perioperative management of Total Knee Arthroplasty (TKA), postoperative fever has always been a concern. Current research focuses on infectious fever, and there is no relevant research on the occurrence of non-infectious fever (NIF) and its risk factors. Hence, the aim of this study was to clarify the risk factors for NIF after TKA, and construct an easy-to-use nomogram. A retrospective cohort study was conducted. Consecutive patients undergoing primary unilateral TKA were divided into the non-infectious fever group and the control group. Clinicopathological characters were collected from electronic medical records. Univariate Logistic regression was used to analyze the related independent risk factors. The optimal threshold for each selected factor and combined index was determined when the Youden index achieved the highest value. And the predictive nomogram was developed by these independent factors. Ultimately, 146 patients were included in this study. Of them, 57 (39.04%) patients experienced NIF. Results of the univariable logistic regression analysis indicated that intraoperative blood loss (OR, 1.002; 95% CI, 1.000-1.0004), postoperative drainage fluid volume (OR, 1.003; 95% CI, 1.001-1.006) and frequency of blood transfusion ( = 1; OR, 0.227; 95% CI, 0.068-0.757) were independent risk factors of NIF occurrence. The predictive nomogram that incorporated the above independent risk factors was developed, and it yielded an areas under the curves (AUC) of 0.731 (95% CI: 0.651-0.801; < 0.0001) with 54.39% sensitivity and 82.02% specificity. Non-infectious fever after TKA prolongs the time of antibiotic use and hospital stay. Our results demonstrated that the nomogram may facilitate to predict the individualized risk of NIF occurrence within 7-day by intraoperative blood loss, postoperative drainage fluid volume and frequency of blood transfusion.
在全膝关节置换术（TKA）的围手术期管理中，术后发热一直是一个令人关注的问题。目前的研究主要集中在感染性发热，而关于非感染性发热（NIF）的发生及其危险因素尚无相关研究。因此，本研究的目的是阐明TKA术后NIF的危险因素，并构建一个易于使用的列线图。进行了一项回顾性队列研究。将连续接受初次单侧TKA的患者分为非感染性发热组和对照组。从电子病历中收集临床病理特征。采用单因素Logistic回归分析相关独立危险因素。当约登指数达到最高值时，确定每个选定因素和综合指标的最佳阈值。并由这些独立因素构建预测列线图。最终，本研究纳入了146例患者。其中，57例（39.04%）患者出现NIF。单因素Logistic回归分析结果表明，术中失血量（OR，1.002；95%CI，1.000 - 1.0004）、术后引流量（OR，1.003；95%CI，1.001 - 1.006）和输血次数（=1；OR，0.227；95%CI，0.068 - 0.757）是NIF发生的独立危险因素。构建了包含上述独立危险因素的预测列线图，其曲线下面积（AUC）为0.731（95%CI：0.651 - 0.801；<0.0001），敏感性为54.39%，特异性为82.02%。TKA术后的非感染性发热延长了抗生素使用时间和住院时间。我们的结果表明，该列线图可能有助于通过术中失血量、术后引流量和输血次数预测7天内NIF发生的个体风险。
