Risk Factors Analysis And Prediction Model Construction Of Incisional Complications After Lumbar Interbody Fusion With Posterior Median Incision

Background and Objective:Posterior median incision lumbar interbody fusion(LIF)is a classic treatment for lumbar degenerative diseases through spinal canal decompression and interbody fusion to reconstruct spinal stability.With the aging of population and the development of surgical instruments and anesthesiology,posterior median incision LIF has been widely used in clinic.However,while the posterior median incision LIF is widely used in clinic,there are more and more surgical complications.Incision complications are the main reasons that affect patients’ recovery and unplanned reoperation.The guidelines emphasize that paying attention to incision complications is as important as paying attention to surgical techniques themselves.In this study,we analyze the risk factors of incision complications after posterior median incision LIF,and establish a line chart prediction model,in order to provide reference for clinical perioperative management,reduce the incidence of postoperative incision complications and improve the prognosis of patients.Methods:The clinical data of patients with posterior median incision LIF hospitalized in our hospital from September 2014 to August 2020 were analyzed retrospectively.Patients with any kind of postoperative incision complications were included in the group with incision complications,and the rest were included in the group without incision complications.Sex,age,history of hypertension,history of diabetes,history of lumbar surgery,main diagnosis and preoperative leukemia count(WBC),neutrophil lymphocyte ratio(NLR),platelet count(Plt),albumin,triglyceride,operation mode,incision length,operation time,operation start time,operation segment number,postoperative antibiotic days,intraoperative blood loss,perioperative blood transfusion and other factors on postoperative incision complications.The clinical data of the two groups were compared and the relevant risk factors were screened,and the risk factors of incision complications after posterior median incision LIF were further verified by univariate Logistic regression analysis,and the independent risk factors were obtained by multivariate unconditional Logistic regression analysis of the risk factors of single factor Logistic regression analysis P < 0.05.the results showed that the risk factors of incisional complications after posterior median incision were verified by univariate Logistic regression analysis.According to the results of multi-factor Logistic regression analysis,the relevant risk factors were included,and the line chart prediction model was constructed.The subject artificial characteristic curve(ROC)was used to evaluate the prediction efficiency,specificity and sensitivity of the prediction model.Results:A total of 520 patients were included in this study,of which 76 cases had postoperative incision complications,with an incidence of 14.62%.Univariate analysis and multivariate unconditional Logistic regression analysis showed that age,history of lumbar surgery,number of operative segments and operation time were independent risk factors for incisional complications after median incision LIF,and their odds ratios((OR))were 1.041,3.287,2.087 and 1.007,respectively.The prediction model of line chart was constructed,and the area under ROC curve AUC=0.752,95%CI=0.713 ～ 789(P < 0.0001)was calculated.The Jordan index,specificity and sensitivity were 0.497,0.721 and 0.776 respectively.Conclusions:The patient’s age,history of lumbar spine surgery,number of operative segments,and operative time are independent risk factors for post-central incision LIF postoperative incision complications..The nomogram prediction model established in this study has good prediction performance and can provide an effective reference for early clinical identification of high-risk populations and early intervention.