Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000, China.
BMC Surg. 2022 Aug 12;22(1):313. doi: 10.1186/s12893-022-01735-4.
Compared with open comminuted calcaneal fractures, less emphasis is placed on postoperative surgical site infection (SSI) of closed comminuted calcaneal fractures. This study aimed to identify the risk factors associated with SSI and build a nomogram model to visualize the risk factors for postoperative SSI.
We retrospectively collected patients with closed comminuted calcaneal fractures from the Second Affiliated Hospital of Wenzhou Medical University database from 2017 to 2020. Risk factors were identified by logistics regression analysis, and the predictive value of risk factors was evaluated by ROC (receiver operating characteristic curve). Besides, the final risk factors were incorporated into R4.1.2 software to establish a visual nomogram prediction model.
The high-fall injury, operative time, prealbumin, aspartate aminotransferase (AST), and cystatin-C were independent predictors of SSI in calcaneal fracture patients, with OR values of 5.565 (95%CI 2.220-13.951), 1.044 (95%CI 1.023-1.064), 0.988 (95%CI 0.980-0.995), 1.035 (95%CI 1.004-1.067) and 0.010 (95%CI 0.001-0.185) (P < 0.05). Furthermore, ROC curve analysis showed that the AUC values of high-fall injury, operation time, prealbumin, AST, cystatin-C, and their composite indicator for predicting SSI were 0.680 (95%CI 0.593-0.766), 0.756 (95%CI 0.672-939), 0.331 (95%CI 0.243-0.419), 0.605 (95%CI 0.512-0.698), 0.319 (95%CI 0.226-0.413) and 0.860 (95%CI 0.794-0.926), respectively (P < 0.05). Moreover, the accuracy of the nomogram to predict SSI risk was 0.860.
Our study findings suggest that clinicians should pay more attention to the preoperative prealbumin, AST, cystatin C, high-fall injury, and operative time for patients with closed comminuting calcaneal fractures to avoid the occurrence of postoperative SSI. Furthermore, our established nomogram to assess the risk of SSI in calcaneal fracture patients yielded good accuracy and can assist clinicians in taking appropriate measures to prevent SSI.
相较于开放性粉碎性跟骨骨折，闭合性粉碎性跟骨骨折术后的手术部位感染（SSI）并不受重视。本研究旨在确定与 SSI 相关的风险因素，并建立列线图模型来可视化术后 SSI 的风险因素。
我们回顾性地从温州医科大学附属第二医院数据库中收集了 2017 年至 2020 年的闭合性粉碎性跟骨骨折患者。通过逻辑回归分析确定风险因素，并通过 ROC（受试者工作特征曲线）评估风险因素的预测价值。此外，最终的风险因素被纳入 R4.1.2 软件中以建立可视化列线图预测模型。
高处坠落伤、手术时间、前白蛋白、天门冬氨酸氨基转移酶（AST）和胱抑素 C 是跟骨骨折患者 SSI 的独立预测因子，比值比（OR）值分别为 5.565（95%CI 2.220-13.951）、1.044（95%CI 1.023-1.064）、0.988（95%CI 0.980-0.995）、1.035（95%CI 1.004-1.067）和 0.010（95%CI 0.001-0.185）（P<0.05）。此外，ROC 曲线分析显示，高处坠落伤、手术时间、前白蛋白、AST、胱抑素 C 及其预测 SSI 的综合指标的 AUC 值分别为 0.680（95%CI 0.593-0.766）、0.756（95%CI 0.672-939）、0.331（95%CI 0.243-0.419）、0.605（95%CI 0.512-0.698）、0.319（95%CI 0.226-0.413）和 0.860（95%CI 0.794-0.926）（P<0.05）。此外，列线图预测 SSI 风险的准确性为 0.860。
本研究结果表明，对于闭合性粉碎性跟骨骨折患者，临床医生应更加关注术前的前白蛋白、AST、胱抑素 C、高处坠落伤和手术时间，以避免术后 SSI 的发生。此外，我们建立的列线图模型可以准确评估跟骨骨折患者 SSI 的风险，可帮助临床医生采取适当的措施预防 SSI。
