Tang Wanyun, Hou Yudong, Bai Chenglin, Shang Yaohua
Department of Orthopedics, Zigong First People's Hospital, Zigong, China.
The First Department of Hand and Foot Surgery, Central Hospital of Dalian University of Technology, No. 826 Southwest Road, Shahekou District, Dalian City, Liaoning Province, China.
Eur J Med Res. 2025 Jul 7;30(1):589. doi: 10.1186/s40001-025-02710-4.
Hip fracture is a common and serious injury in older adults, with an increasing incidence as the population ages. Postoperative pneumonia (POP) is a common complication after hip fracture surgery, and is associated with increased mortality, morbidity, and length of hospital stay. The purpose of this study was to develop and validate a nomogram to predict the risk of POP in geriatric patients with hip fracture.
We conducted a retrospective cohort study of geriatric patients who underwent hip fracture surgery in our hospital between Feb 2015 and Feb 2024. The cohort was randomly divided into training (n = 908) and validation (n = 388) sets. We used least absolute shrinkage and selection operator (LASSO) regression and logistic regression to identify independent risk factors for POP in the training set and constructed a nomogram using these predictors. The performance of the nomogram was evaluated by the C-index, Receiver Operating Characteristic (ROC) analysis, calibration plots, and decision curve analysis.
A total of 1296 patients were included in the study. The incidence of POP was 9.1%. The nomogram included the following variables: age, sex, Chronic Obstructive Pulmonary Disease (COPD), postoperative Intensive Care Unit (ICU), American Society of Anesthesiologists (ASA) classification, blood glucose, album. The nomogram for predicting POP achieved an area under the curve (AUC) of 0.874 (training set) and 0.840 (validation set). Furthermore, C-index, calibration plots and decision curve analysis demonstrated the adequate performance of the nomogram in both the training and validation sets.
The nomogram is a well-calibrated and discriminative tool that can be used to predict the risk of POP in geriatric patients with hip fracture. The nomogram may be useful for identifying patients who may benefit from preventive measures.
髋部骨折是老年人常见且严重的损伤，随着人口老龄化，其发病率不断上升。术后肺炎（POP）是髋部骨折手术后常见的并发症，与死亡率、发病率的增加以及住院时间延长相关。本研究的目的是开发并验证一种列线图，以预测老年髋部骨折患者发生POP的风险。
我们对2015年2月至2024年2月在我院接受髋部骨折手术的老年患者进行了一项回顾性队列研究。该队列被随机分为训练集（n = 908）和验证集（n = 388）。我们使用最小绝对收缩和选择算子（LASSO）回归和逻辑回归来确定训练集中POP的独立危险因素，并使用这些预测因子构建列线图。通过C指数、受试者工作特征（ROC）分析、校准图和决策曲线分析来评估列线图的性能。
本研究共纳入1296例患者。POP的发生率为9.1%。列线图包括以下变量：年龄、性别、慢性阻塞性肺疾病（COPD）、术后入住重症监护病房（ICU）、美国麻醉医师协会（ASA）分级、血糖、白蛋白。预测POP的列线图在训练集的曲线下面积（AUC）为0.874，在验证集为0.840。此外，C指数、校准图和决策曲线分析表明列线图在训练集和验证集均表现良好。
该列线图是一种校准良好且具有鉴别力的工具，可用于预测老年髋部骨折患者发生POP的风险。该列线图可能有助于识别可能从预防措施中获益的患者。
