The influencing factors of postoperative delirium in patients with severe multiple fractures trauma and the construction of its nomogram risk prediction model

Yuan Zhihao; Chen Fangshun; Li Yixin; Cai Yating; Liu Jinhua

doi:10.3760/j.issn.1673-4777.2025.07.017

Abstract：Objective To explore the risk factors of postoperative delirium in patients with severe multiple fracture trauma,and to establish and verify a nomogram model.Methods A total of 220 patients with severe multiple fracture trauma who were treated and operated in the 910th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army from January 2019 to December 2022 were selected as the modeling set.Another 94 patients with severe multiple fracture trauma from January to December 2023 were selected as the validation set.According to whether delirium occurred,the patients in the modeling set were divided into non-delirium group(147 cases)and delirium group(73 cases).The clinical data of non-delirium group and delirium group were compared.The risk factors of postoperative delirium were analyzed,and the accuracy of the nomogram model was established and verified.Results The age,injury severity(ISS)score,length of intensive care unit(ICU)stay,the proportions of patients with physical restraint,American Society of Anesthesiologists(ASA)gradeⅢ-Ⅳ,mechanical ventilation,and general anesthesia were significantly greater/higher in the delirium group than in the non-delirium group,and the preoperative albumin level was significantly lower in the delirium group than in the non-delirium group(all P＜0.05).Multivariate Logistic regression analysis showed that age ≥ 60 years,preoperative albumin ≤30 g/L,ASA grade Ⅲ-Ⅳ,ISS score ≥21,general anesthesia and ICU stay ≥9 days were independent risk factors for preoperative albumin(all P＜0.05).The receiver operating characteristic curve showed that the area under the curve of the modeling set and the validation set were 0.803(95％confidence interval:0.706-0.875)and 0.818(95％confidence interval:0.678-0.962),respectively,which showed good prediction accuracy.The calibration curve of the nomogram risk prediction model showed that the predictions of the modeling set and the validation set were in good agreement with the observations.The P values of Hosmer-Lemeshow test were 0.405 and 0.669,respectively,and the P values were not significant.Conclusion The nomogram risk prediction model based on age ≥60 years,preoperative albumin ≤30 g/L,ASA grade Ⅲ-Ⅳ,ISS score ≥21,general anesthesia and ICU stay ≥9 days has good accuracy in predicting postoperative delirium in patients with severe multiple fracture trauma,which can be used to guide clinical preventive intervention measures.