Objective To identify risk factors influencing ICU transfer after orthopedic surgery in patients with multiple trauma and to develop a corresponding predictive model. Methods A total of 300 patients with orthopedic multiple trauma admitted to our hospital from January 2020 to January 2025 were retrospectively selected as the research subjects. They were divided into a modeling set (n=210) and a validation set (n=90) using simple random grouping in a 7∶3 ratio. Patients were classified into the transfer group and the non-transfer group based on whether they were transferred to the ICU after surgery. Risk factors for postoperative ICU transfer were screened, and a prediction model was constructed. Results Among the 210 patients in the modeling set, 61(29.05%) were transferred to the ICU, while 26 (28.89%) of the 90 patients in the validation set were transferred to the ICU. Multivariate Logistic regression analysis showed that age, ASA grade, ISS score, emergency surgery, intraoperative blood loss, intraoperative hypotension or hypoxemia, postoperative GCS score, urine output at 6 h postoperatively, and Hb, D-dimer, SpO2, Lac, PT, ALB, and Cr levels within 6 h postoperatively were independent factors associated with postoperative ICU transfer (all P<0.05). No significant multicollinearity was observed among these factors. LASSO regression further identified six core predictors, including ASA grade, ISS score, emergency surgery, intraoperative blood loss, SpO2 within 6 h postoperatively, and Lac, which were used to construct the nomogram. The AUC was 0.783 (95%CI: 0.677-0.889) in the modeling set and 0.771 (95%CI: 0.554-0.823) in the validation set. The model showed good calibration and clinical net benefit. Conclusions The ICU-transfer risk nomogram, based on ASA class, ISS score, emergency surgery, intra-operative blood loss, postoperative 6 h SpO2, and lactate level, exhibits good discriminative performance and calibration. It can serve as a practical tool to support clinical decision-making in orthopedic patients with multiple trauma.
Key words
orthopedics /
multiple trauma /
postoperative /
ICU transfer /
risk prediction model
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