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External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study

Although several models for the prediction of surgical complications after primary total hip or total knee replacement (THA and TKA, respectively) are available, only a few models have been externally validated. The aim of this study was to externally validate four previously developed models for th...

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Autores principales: Sweerts, Lieke, Dekkers, Pepijn W., van der Wees, Philip J., van Susante, Job L. C., de Jong, Lex D., Hoogeboom, Thomas J., van de Groes, Sebastiaan A. W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964485/
https://www.ncbi.nlm.nih.gov/pubmed/36836512
http://dx.doi.org/10.3390/jpm13020277
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author Sweerts, Lieke
Dekkers, Pepijn W.
van der Wees, Philip J.
van Susante, Job L. C.
de Jong, Lex D.
Hoogeboom, Thomas J.
van de Groes, Sebastiaan A. W.
author_facet Sweerts, Lieke
Dekkers, Pepijn W.
van der Wees, Philip J.
van Susante, Job L. C.
de Jong, Lex D.
Hoogeboom, Thomas J.
van de Groes, Sebastiaan A. W.
author_sort Sweerts, Lieke
collection PubMed
description Although several models for the prediction of surgical complications after primary total hip or total knee replacement (THA and TKA, respectively) are available, only a few models have been externally validated. The aim of this study was to externally validate four previously developed models for the prediction of surgical complications in people considering primary THA or TKA. We included 2614 patients who underwent primary THA or TKA in secondary care between 2017 and 2020. Individual predicted probabilities of the risk for surgical complication per outcome (i.e., surgical site infection, postoperative bleeding, delirium, and nerve damage) were calculated for each model. The discriminative performance of patients with and without the outcome was assessed with the area under the receiver operating characteristic curve (AUC), and predictive performance was assessed with calibration plots. The predicted risk for all models varied between <0.01 and 33.5%. Good discriminative performance was found for the model for delirium with an AUC of 84% (95% CI of 0.82–0.87). For all other outcomes, poor discriminative performance was found; 55% (95% CI of 0.52–0.58) for the model for surgical site infection, 61% (95% CI of 0.59–0.64) for the model for postoperative bleeding, and 57% (95% CI of 0.53–0.61) for the model for nerve damage. Calibration of the model for delirium was moderate, resulting in an underestimation of the actual probability between 2 and 6%, and exceeding 8%. Calibration of all other models was poor. Our external validation of four internally validated prediction models for surgical complications after THA and TKA demonstrated a lack of predictive accuracy when applied in another Dutch hospital population, with the exception of the model for delirium. This model included age, the presence of a heart disease, and the presence of a disease of the central nervous system as predictor variables. We recommend that clinicians use this simple and straightforward delirium model during preoperative counselling, shared decision-making, and early delirium precautionary interventions.
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spelling pubmed-99644852023-02-26 External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study Sweerts, Lieke Dekkers, Pepijn W. van der Wees, Philip J. van Susante, Job L. C. de Jong, Lex D. Hoogeboom, Thomas J. van de Groes, Sebastiaan A. W. J Pers Med Article Although several models for the prediction of surgical complications after primary total hip or total knee replacement (THA and TKA, respectively) are available, only a few models have been externally validated. The aim of this study was to externally validate four previously developed models for the prediction of surgical complications in people considering primary THA or TKA. We included 2614 patients who underwent primary THA or TKA in secondary care between 2017 and 2020. Individual predicted probabilities of the risk for surgical complication per outcome (i.e., surgical site infection, postoperative bleeding, delirium, and nerve damage) were calculated for each model. The discriminative performance of patients with and without the outcome was assessed with the area under the receiver operating characteristic curve (AUC), and predictive performance was assessed with calibration plots. The predicted risk for all models varied between <0.01 and 33.5%. Good discriminative performance was found for the model for delirium with an AUC of 84% (95% CI of 0.82–0.87). For all other outcomes, poor discriminative performance was found; 55% (95% CI of 0.52–0.58) for the model for surgical site infection, 61% (95% CI of 0.59–0.64) for the model for postoperative bleeding, and 57% (95% CI of 0.53–0.61) for the model for nerve damage. Calibration of the model for delirium was moderate, resulting in an underestimation of the actual probability between 2 and 6%, and exceeding 8%. Calibration of all other models was poor. Our external validation of four internally validated prediction models for surgical complications after THA and TKA demonstrated a lack of predictive accuracy when applied in another Dutch hospital population, with the exception of the model for delirium. This model included age, the presence of a heart disease, and the presence of a disease of the central nervous system as predictor variables. We recommend that clinicians use this simple and straightforward delirium model during preoperative counselling, shared decision-making, and early delirium precautionary interventions. MDPI 2023-01-31 /pmc/articles/PMC9964485/ /pubmed/36836512 http://dx.doi.org/10.3390/jpm13020277 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sweerts, Lieke
Dekkers, Pepijn W.
van der Wees, Philip J.
van Susante, Job L. C.
de Jong, Lex D.
Hoogeboom, Thomas J.
van de Groes, Sebastiaan A. W.
External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study
title External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study
title_full External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study
title_fullStr External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study
title_full_unstemmed External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study
title_short External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study
title_sort external validation of prediction models for surgical complications in people considering total hip or knee arthroplasty was successful for delirium but not for surgical site infection, postoperative bleeding, and nerve damage: a retrospective cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964485/
https://www.ncbi.nlm.nih.gov/pubmed/36836512
http://dx.doi.org/10.3390/jpm13020277
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