Effect of a risk-stratified intervention strategy on surgical complications: experience from a multicentre prospective study in China

Yu, Xinmin; Jiang, Jingmei; Shang, Hong; Wu, Shizheng; Sun, Huawei; Li, Hanzhong; Xin, Shijie; Zhao, Shengxiu; Huang, Yuguang; Wu, Xinjuan; Zhang, Xu; Wang, Yaolei; Xue, Fang; Han, Wei; Wang, Zixing; Hu, Yimin; Wang, Lei; Zhao, Yupei

doi:10.1136/bmjopen-2018-025401

Cited by 7 publications

(2 citation statements)

References 42 publications

(56 reference statements)

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“…Several studies have proved an association between higher BMI and postoperative infection [ 24 , 25 ]. Xiaochu Yu et al [ 24 ] also found that obese patients undergoing acetabular fracture surgery had an increased rate of wound infection compared with non-obese patients. Patients with BMI over 28 kg/m 2 were five times more likely to have a wound infection.…”

Section: Discussionmentioning

confidence: 99%

Development of a nomogram to predict surgical site infection after open reduction and internal fixation for closed pilon fracture: a prospective single-center study

Xie

Wang

et al. 2023

J Orthop Surg Res

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Background To explore the risk factors and develop a nomogram in order to predict surgical site infection (SSI) after open reduction and internal fixation (ORIF) for closed pilon fractures (CPF). Methods A prospective cohort study with one-year follow-up was carried out in a provincial trauma center. From January 2019 to January 2021, 417 adult patients with CPFs receiving ORIF were enrolled. A Whitney U test or t test, Pearson chi-square test, and multiple logistic regression analyses were gradually used for screening the adjusted factors of SSI. A nomogram model was built to predict the risk of SSI, and the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used for evaluating the prediction performance and consistency of the nomogram model. The bootstrap method was employed to test the validity of the nomogram. Results The incidence of SSI after ORIF for CPFs was 7.2% (30/417): 4.1% (17/417) of superficial SSIs and 3.1% (13/417) of deep SSIs. The most common pathogenic bacteria were Staphylococcus aureus (36.6%, 11/30). The multivariate analysis showed tourniquet use, longer preoperative stay, lower preoperative albumin (ALB), higher preoperative body mass index (BMI) and hypersensitive C-reactive protein (Hs-CRP) were independent risk factors of SSI. Additionally, the C-index and bootstrap value of the nomogram model were 0.838 and 0.820, respectively. Finally, the calibration curve indicated that the actual diagnosed SSI had good consistency with the predicted probability, and the DCA showed that the nomogram had clinical value. Conclusions Tourniquet use, longer preoperative stay, lower preoperative ALB, higher preoperative BMI and Hs-CRP were five independent risk factors of SSI after closed pilon fractures treated by ORIF. These five predictors are shown on the nomogram, with which we may be able to further prevent the CPS patients from SSI. Trial registration NO 2018-026-1, October /24/2018, prospectively registered. The study was registered in October 24, 2018. The study protocol was designed based on the Declaration of Helsinki and admitted by the Institutional Review Board. The ethics committee approved the study on factors related to fracture healing in orthopedic surgery. Data analyzed in the present study were acquired from the patients who underwent open reduction and internal fixation from January 2019 to January 2021.

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Section: Discussionmentioning

confidence: 99%

Development of a nomogram to predict surgical site infection after open reduction and internal fixation for closed pilon fracture: a prospective single-center study

Xie

Wang

et al. 2023

J Orthop Surg Res

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“…For comparability, the complications were similar to those used in RCTs [22,23]. The de nitions of these complications are detailed in a previous report [24]. To have a su cient sample size for the stability of the results, we de ned a composite outcome by combining death and all complications.…”

Section: Exposure and Outcomesmentioning

confidence: 99%

Feasibility of a Restrictive Transfusion Strategy for Patients Undergoing Malignant Tumour Resection: A Multicentre Prospective Observational Study

Yu,

Chen,

Wang

et al. 2024

Preprint

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Background The recommended transfusion threshold for surgical oncology patients remains unclear owing to insufficient evidence from randomized controlled trials. Evidence from observational studies has been questioned because of huge patient heterogeneity. We aimed to assess the safety of restrictive transfusion at a minimum tolerable haemoglobin threshold for surgical oncology patients with observational data using a tailored design and analysis. Methods Data were collected from four representative regional hospitals in China during 2015 − 2016. Surgical inpatients with seven types of cancer (total cancers) comprised 6055 participants as the base population. In our design, we (1) derived a primary analytic sample by the interested zone of transfusion decision: 6–10 g/dL; (2) selected the control group according to trigger haemoglobin threshold; (3) evaluated the patient heterogeneity between the transfused and non-transfused groups with key covariates according to standardized mean difference (SMD) values. Analysis is mainly based on two datasets: The base population to obtain a natural pattern of transfusion practice; and the primary analytic sample to evaluate the safety of a restrictive transfusion strategy. Results In the base population, 836 (13.81%) were transfused and showed high heterogeneity compared with non-transfused patients (SMD: 7.1–71.31%); there was a significant positive association between transfusion and the composite outcome (in-hospital complications and death) (P < 0.05). In the primary analytic sample, patient heterogeneity was greatly reduced (all SMD ≤ 10%). Compared with non-transfusion, transfusion no longer increased the risk of the composite outcome for total cancers at haemoglobin 6–10 g/dL (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 0.71–1.98), especially for colorectal cancer at 6 − 8 g/dL (OR: 0.54, 95% CI: 0.17–1.68). Compared with those transfused at haemoglobin 8–10 g/dL, patients transfused at 6–8 g/dL did not increase the risk of the composite outcome for total cancers (OR: 1.08, 95% CI: 0.44–2.65), especially for colorectal cancer (OR: 0.46, 95% CI: 0.12–1.82). Conclusions A restrictive transfusion threshold of 8 g/dL may be feasible for total cancers, with a threshold as low as 6 g/dL for colorectal cancer. Restrictive transfusion evidence can be complemented with observational data using a tailored design and analysis.

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2022

Applied Medical Statistics

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Effect of a risk-stratified intervention strategy on surgical complications: experience from a multicentre prospective study in China

Cited by 7 publications

References 42 publications

Development of a nomogram to predict surgical site infection after open reduction and internal fixation for closed pilon fracture: a prospective single-center study

Development of a nomogram to predict surgical site infection after open reduction and internal fixation for closed pilon fracture: a prospective single-center study

Feasibility of a Restrictive Transfusion Strategy for Patients Undergoing Malignant Tumour Resection: A Multicentre Prospective Observational Study

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