Qi Hui, Duan Wei, Jia Ruili, Wang Shuai, An Ming, Long Yubin
Department of Orthopedic Surgery, Baoding First Central Hospital of Hebei Medical University, Baoding, China.
Department of Nephrology, Baoding First Central Hospital of Hebei Medical University, Baoding, China.
J Orthop Surg Res. 2024 Dec 18;19(1):830. doi: 10.1186/s13018-024-05335-1.
Patellar fractures are a common knee injury among elderly patients, with a high risk of developing surgical site infections (SSI) postoperatively, which severely affects patient prognosis and quality of life. Elderly patients are more susceptible to SSI due to various factors such as decreased immune function and chronic diseases. Therefore, identifying the risk factors for SSI is of great clinical significance for prevention.
This study aims to analyze the risk factors for postoperative SSI in elderly patients with patellar fractures, providing a basis for developing more effective clinical prevention and treatment strategies.
This retrospective study collected data from 856 elderly patients who underwent patellar fracture surgery at Baoding First Central Hospital between January 2017 and December 2023. Patients were divided into SSI and non-SSI groups based on the occurrence of SSI, and their demographic data, comorbidities, and laboratory results were analyzed. Logistic regression was used to identify independent risk factors for SSI, and ROC curve analysis was conducted to determine the optimal cutoff point for predictive indicators.
The incidence of SSI was found to be 2.1%. Univariate analysis showed that BMI, surgical delay, diabetes, hematocrit (HCT), and albumin (ALB) were significantly associated with SSI. Logistic regression analysis further confirmed that BMI (p = 0.043), surgical delay (p = 0.000), HCT (p = 0.038), ALB (p = 0.015), and diabetes (p = 0.022) were independent risk factors for SSI. ROC curve analysis indicated that the optimal cutoff points for BMI, HCT, and ALB were 25.39 kg/m, 35.62%, and 39.3 g/L, respectively, with an AUC of 0.794 for the combined predictive indicators.
High BMI, surgical delay, diabetes, low HCT, and low ALB are independent risk factors for postoperative SSI in elderly patients with patellar fractures. Preoperative management targeting these high-risk factors, such as optimizing patient weight, controlling diabetes, and improving nutritional status, can effectively reduce the incidence of SSI and improve postoperative outcomes. Future multicenter studies may further validate these findings and provide additional prevention strategies.
髌骨骨折是老年患者常见的膝关节损伤，术后发生手术部位感染（SSI）的风险较高，严重影响患者预后和生活质量。由于免疫功能下降和慢性疾病等多种因素，老年患者更容易发生SSI。因此，识别SSI的危险因素对预防具有重要的临床意义。
本研究旨在分析老年髌骨骨折患者术后SSI的危险因素，为制定更有效的临床防治策略提供依据。
本回顾性研究收集了2017年1月至2023年12月在保定市第一中心医院接受髌骨骨折手术的856例老年患者的数据。根据SSI的发生情况将患者分为SSI组和非SSI组，并分析其人口统计学数据、合并症和实验室检查结果。采用Logistic回归分析确定SSI的独立危险因素，并进行ROC曲线分析以确定预测指标的最佳截断点。
发现SSI的发生率为2.1%。单因素分析显示，体重指数（BMI）、手术延迟、糖尿病、血细胞比容（HCT）和白蛋白（ALB）与SSI显著相关。Logistic回归分析进一步证实，BMI（p = 0.043）、手术延迟（p = 0.000）、HCT（p = 0.038）、ALB（p = 0.015）和糖尿病（p = 0.022）是SSI的独立危险因素。ROC曲线分析表明，BMI、HCT和ALB的最佳截断点分别为25.39kg/m²、35.62%和39.3g/L，联合预测指标的曲线下面积（AUC）为0.794。
高BMI、手术延迟、糖尿病、低HCT和低ALB是老年髌骨骨折患者术后SSI的独立危险因素。针对这些高危因素进行术前管理，如优化患者体重、控制糖尿病和改善营养状况，可以有效降低SSI的发生率并改善术后结局。未来的多中心研究可能会进一步验证这些发现并提供额外的预防策略。
