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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2023

28-06-2023 | Phlebothrombosis | KNEE

Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy

Authors: Haichuan Guo, Tianyu Wang, Chengsi Li, Jiahao Yu, Ruoxuan Zhu, Maolin Wang, Yanbin Zhu, Juan Wang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2023

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Abstract

Purpose

This study aimed to identify independent risk factors for immediate postoperative deep vein thrombosis (DVT) in patients with open wedge high tibial osteotomy (OWHTO) and to develop and validate a predictive nomogram.

Methods

Patients who underwent OWHTO for knee osteoarthritis (KOA) from June 2017 to December 2021 were retrospectively analyzed. Baseline data and laboratory test results were collected, and the occurrence of DVT in the immediate postoperative period was regarded as the study outcome event. Multivariable logistic regression identified independent risk factors associated with a higher incidence of immediate postoperative DVT. The predictive nomogram was constructed based on the analysis results. The stability of the model was further assessed in this study using patients from January to September 2022 as an external validation set.

Results

741 patients were enrolled in the study, of which 547 were used in the training cohort and the other 194 for the validation cohort. Multivariate analysis revealed a higher Kellgren–Lawrence (K–L) grade (III vs. I–II OR 3.09, 95% CI 0.93–10.23. IV vs. I–II OR 5.23, 95% CI 1.27–21.48.), platelet to hemoglobin ratio (PHR) > 2.25 (OR 6.10, 95% CI 2.43–15.33), Low levels of albumin (ALB) (OR 0.79, 95% CI 0.70–0.90), LDL-C > 3.40 (OR 3.06, 95% CI 1.22–7.65), d-dimer > 1.26 (OR 2.83, 95% CI 1.16–6.87) and BMI ≥ 28 (OR 2.57, 95% CI 1.02–6.50) were the independent risk factors of immediate postoperative DVT. The concordance index (C-index) and Brier score of the nomogram were 0.832 and 0.036 in the training set, and the corrected values after internal validation were 0.795 and 0.038, respectively. The receiver-operating characteristic (ROC) curve, the calibration curve, the Hosmer–Lemeshow test, and the decision curve analysis (DCA) performed well in both the training and validation cohorts.

Conclusion

This study developed a personalized predictive nomogram with six predictors, which allows surgeons to stratify risk and recommended immediate ultrasound scans for patients with any of these factors.

Level of evidence

III.
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Metadata
Title
Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy
Authors
Haichuan Guo
Tianyu Wang
Chengsi Li
Jiahao Yu
Ruoxuan Zhu
Maolin Wang
Yanbin Zhu
Juan Wang
Publication date
28-06-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07488-8

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