Dynamic nomogram of intraoperative hypotension in elderly patients with intertrochanteric femur fractures
Objective To construct a dynamic nomogram of intraoperative hypotension(IH)in pa-tients undergoing closed reduction intramedullary pin internal fixation in elderly patients with intertrochanteric femur fracture(ITFF).Methods Two hundred and eleven patients,69 males and 142 fe-males,aged 65-85 years,with BMI 18.5-28.0 kg/m2 and ASA physical statusⅡorⅢ,were selected to be treated with closed reduction intramedullary pin internal fixation for ITFF in the elderly patients.Patients were divided into two groups according to whether IH occurred intraoperatively:group IH and the control group(group CO).Underlying diseases,vasoactive drug use,fracture site,modified 5-item frailty index(mFI-5)score,and clinical laboratory tests including hemoglobin(Hb),platelets(PLT),white blood cells(WBC),albumin(ALB),C-reactive protein(CRP),blood urea nitrogen(BUN),serum creatinine(SCr),and fasting blood glucose(FBG)were recorded.Baseline blood pressure,SBP and DBP before in-duction of anesthesia,15,45,and 75 minutes after induction of anesthesia,mean intraoperative tempera-ture,intraoperative blood loss,anesthesia time and operation time were recorded.Multifactorial logistic re-gression analysis was used to explore the risk factors of IH in ITFF patients,and a nomogram of IH risk was constructed and validated by R programing larguage.Dynamic nomogram were further developed using the DynNom package.Results The incidence of IH in elderly ITFF patients was 40.3%.Compared with group CO,patients in group IH had significantly higher females,age,mFI-5,CRP,BUN,FBG,intraoperative blood loss,and significantly lower Hb and ALB,longer anaesthesia time and operation time(P＜0.05).Multifactorial logistic regression analysis showed that females(OR=1.672,95%CI 1.168-2.654,P=0.017),increased age(OR=2.039,95%CI 1.268-4.685,P＜0.001),elevated mFI-5(OR=2.150,95%CI 1.532-3.068,P＜0.001),decreased ALB(OR=0.739,95%CI 0.634-0.987,P=0.021),increased FBG(OR=1.712,95%CI 0.971-2.135,P＜0.001)and prolonged anesthesia(OR=1.068,95%CI 0.965-1.864,P=0.019)were independent risk factors for developing IH.A no-mogram of IH risk was constructed based on the above variables,and its calibration curve showed a consis-tency index of 0.972 with high predictive accuracy.The results of decision curve analysis showed that the nomogram risk threshold was greater than 0.032,providing a clearly meaningful net clinical benefit.The no-mogram was visualized as a dynamic nomogram of IH risk(https://mldynamic.shinyapps.io/DynNomapp/).Conclusion This study constructed a dynamic nomogram of IH risk among elderly ITFF patients based on gender,age,mFI-5,ALB,FBG,and anesthesia time,which can help to make more ag-gressive treatment decisions and provide a reference for IH management.
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