Department of Orthopedics Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
J Orthop Surg Res. 2024 Aug 22;19(1):498. doi: 10.1186/s13018-024-04921-7.
BACKGROUND: The Achilles tendon is the body's strongest and largest tendon. It is commonly injured, particularly among athletes, accounting for a significant portion of serious tendon injuries. Several factors play a precipitating role in increasing the risk of these injuries. OBJECTIVE: Our objective is to derive and validate a risk calculator for the prediction of incidence of any complication following Achilles tendon repair. METHODS: We used de-identified data from the American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) database from 2005 to 2021. It comprises 7010 individuals who had undergone Achilles tendon rupture repair. Demographic and risk factors information was collected. To develop the calculator, the sample was divided into a derivation cohort (40%) and a validation cohort (60%). Multivariate logistic regression was used for statistical analysis, and a risk calculator for incidence of any complication was derived from the derivation cohort and validated on the remaining 60% of the sample. Patients with missing data were excluded, and the significance level was set at p < 0.05. RESULTS: We analyzed the derivation cohort of 2245 individuals who underwent Achilles tendon repair surgery between 2005 and 2021, with a 5.5% overall complication. Multivariate logistic regression identified anesthesia type, ASA classification, certain co-morbidities (pre-operative dialysis and medication-requiring hypertension), and wound classification as significant predictors of complications. The developed risk calculator model had an area under the curve (AUC) of 0.685 in the derivation cohort and 0.655 in the validation cohort, surpassing the widely used and validated modified frailty index. A cut-off score threshold of 0.06 was established using Youden's index to dichotomize individuals into low and high risk for developing any postoperative complications. CONCLUSION: Our risk calculator includes factors that most significantly affect the incidence of any complication following Achilles tendon repair.
背景：跟腱是人体最强壮、最大的肌腱。它常发生损伤，尤其是在运动员中，占严重跟腱损伤的很大一部分。有几个因素在增加这些损伤的风险方面起着促成作用。
目的：我们的目的是推导和验证一种预测跟腱修复术后任何并发症发生率的风险计算器。
方法：我们使用了美国外科医师学会国家手术质量改进计划（NSQIP）数据库 2005 年至 2021 年期间的去识别数据，其中包括 7010 名接受跟腱断裂修复的个体。收集了人口统计学和风险因素信息。为了开发计算器，将样本分为推导队列（40%）和验证队列（60%）。使用多变量逻辑回归进行统计分析，从推导队列中推导出用于任何并发症发生率的风险计算器，并在其余 60%的样本上进行验证。排除了缺失数据的患者，且显著性水平设置为 p < 0.05。
结果：我们分析了 2005 年至 2021 年间接受跟腱修复手术的 2245 名个体的推导队列，总体并发症发生率为 5.5%。多变量逻辑回归确定了麻醉类型、ASA 分类、某些合并症（术前透析和需要药物治疗的高血压）以及伤口分类是并发症的显著预测因素。所开发的风险计算器模型在推导队列中的曲线下面积（AUC）为 0.685，在验证队列中的 AUC 为 0.655，超过了广泛使用和验证的改良虚弱指数。使用约登指数确定了 0.06 的截断分数阈值，将个体分为发生任何术后并发症的低风险和高风险组。
结论：我们的风险计算器包括了对跟腱修复术后任何并发症发生率影响最大的因素。
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