Analysis of related factors of scheduled ICU before primary hip arthroplasty.

Background: Methods for improving the safety of medical treatments for patients, reducing the occurrence of postoperative complications and optimizing medical resources for primary hip replacement are needed. Previous literature has mostly analysed the risk factors and constructed and models to predict a transfer to the ICU after surgery, and no reports on preoperative ICU reservations have been found. This study evaluated the risk factors for preoperative ICU reservation and considered the necessity of preoperative ICU reservations to optimize preoperative communication, enable a seamless transfer between the operating room and ICU, reduce postoperative complications and shorten hospital stays.

Methods: We extracted the data of 1488 patients who underwent hip replacement from the hospital case database from November 2017 to May 2021 and used the case-control test to divide the patients into the case group (scheduled ICU admission, 134 cases) and the control group (Not scheduled ICU admission, 213 cases). The general conditions of the patients before surgery, including sex, age, Charlson comorbidity index, laboratory test results, and anaesthesia methods, were collected and used as independent variables. The t test, rank sum test, and X test were used to analyse and identify significant factors with a P < 0.05. Then, these factors were entered into binary logistic regression analysis, and a ROC curve was used to test the efficacy of the regression model.

Results: In the data we collected, 134 patients were planned to be transferred to the ICU, and 213 patients were not transferred to the ICU. The two groups of data were analyzed by logistic regression. We defined the risk factors for preoperative ICU appointment in patients with primary hip arthroplasty, including age. (odds ratio (OR) 1.066, 95% (confidence interval) CI (1.039, 1.093), P < 0.001), general anesthesia ( (OR) 1.821, 95%CI (1.165, 2.845), P = 0.008), preoperative C-reactive protein ((OR) 1.016, 95%CI (1.010, 1.022), P < 0.05), preoperative alanine aminotransferase ((OR) 1.042, 95%CI ((1.016, 1.070)), P = 0.002). These were promoting factors for preoperative ICU appointment,and preoperative albumin ((OR) 0.0839, 95%CI (0.792, 0.889)), P < 0.05) was a protective factor for ICU appointment.

Conclusion: For patients requiring primary hip replacement. Age, general anesthesia, preoperative C-reactive protein, preoperative alanine aminotransferase and preoperative albumin are the key points of our preoperative assessment. Paying attention to the changes of these indicators will help surgeons assess the patient's condition and contact the ICU in advance.These data can be fully understood by the patients' families, reduce the unnecessary use of medical resources, and optimize perioperative management.