A Nomogram Prediction Model Integrating TEG and Clinical Features for Postoperative Lower Extremity DVT in TF Patients.

BACKGROUND

The goal was to identify risk factors for postoperative lower extremity deep vein thrombosis (DVT) in traumatic lower limb fracture patients and establish a nomogram prediction model for clinical risk assessment and management.

METHODS

A total of 136 lower extremity traumatic fracture (LETF) patients admitted to the emergency surgery department were enrolled. Patients were divided into DVT and non-DVT groups based on postoperative color Doppler ultrasonography. Univariate and multivariable logistic regression analyses were performed to determine independent risk factors for DVT. A nomogram prediction model was constructed and validated using receiver operating characteristic curve analysis, calibration curve, and decision curve analysis (DCA).

RESULTS

Among 136 patients, 52 developed DVT, while 84 did not. No significant differences were observed in age, gender, BMI, hypertension, coronary artery disease, time from injury to surgery, operative duration, or American Society of Anesthesiologists score (all p > 0.05). However, diabetes prevalence, intraoperative transfusion rate, hip versus tibiofibular fracture distribution, injury severity score (ISS) score ≥ 25, hemoglobin, hematocrit, fibrinogen (FIB), and D-Dimer (D-D) levels differed significantly (all p < 0.05). Thromboelastography (TEG) revealed significantly higher maximum amplitude (MA) and α-angle, but lower clot formation time (K) value in the DVT group (all p < 0.001). Multivariable analysis identified hip fracture, ISS ≥ 25, elevated FIB, elevated D-D, increased MA, and decreased K as independent risk factors (all p < 0.05). The nomogram demonstrated excellent predictive performance (area under the curve = 0.89, 95% confidence interval: 0.77 - 1.00), good calibration (Hosmer-Lemeshow test p > 0.05), and clinical utility on DCA.

CONCLUSIONS

The TEG-based nomogram incorporating clinical features effectively predicts postoperative DVT risk in traumatic fracture patients, facilitating early identification of high-risk individuals and personalized pro-phylaxis to mitigate DVT incidence and improve outcomes.