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在脊柱融合手术中开发和验证用于手术前血型和抗体测试的风险预测名图
Linghong Wu1, Xiaozhong Peng2, Xianglong Zhuo2
1Guangxi Key Laboratory of Orthopaedic Biomaterials Development and Clinical Translation, Liuzhou Worker's Hospital, Liuzhou, China.
Orthopaedic surgery
|December 3, 2023
概括
一个新的名图预测了脊髓融合患者的输血风险,识别了那些需要手术前检测的人. 这种方法可以减少不必要的血型和抗体查 (T&S) 测试,并降低医疗保健成本.
科学领域:
- 整形外科手术 整形外科手术
- 输血医学 输血医学
- 卫生经济学 卫生经济学
背景情况:
- 最少侵入性脊柱融合手术正在增加,导致输血率下降.
- 常规的手术前 ABO/Rh 血型和抗体查 (T&S) 可能对所有脊髓融合患者来说都不具有成本效益.
- 需要一个预测模型来选择性地识别需要术前T&S的患者.
研究的目的:
- 开发一种预测脊髓融合手术患者输血风险的诺莫图.
- 为了能够选择性地安排手术前的T&S测试.
- 减少与不必要的T&S相关的医疗保健和患者成本.
主要方法:
- 对5048名脊髓融合患者的回顾性分析 (01/2020-03/2023).
- 通过 LASSO 和多变量逻辑回归,确定了输血风险因素.
- 使用C指数,Hosmer-Lemeshow测试,校准曲线,ROC AUC和决策曲线分析 (DCA) 验证的诺莫格拉姆模型.
主要成果:
- 确定了十个独立预测因素:女性性别,年龄,BMI,入院路线,危急状态,手术时间,心力衰竭,ESRD/CKD,贫血和凝血缺陷.
- 命名图表表现出良好的区分能力 (C指数=0.887) 和校准.
- 模型应用可以消除82-84%的T&S测试,节省大量成本 (RMB 349,320 - 153,120) 具有高负预测值 (97.9-98.2%).
结论:
- 开发的诺米图有效预测脊髓融合手术中的输血风险.
- 它促进了针对性的手术前T&S测试,优化了资源配置.
- 这一策略大大降低了医疗保健支出,提高了临床效率.
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