A Nomogram for Predicting 30-day Mortality in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fractures

Abstract

Introduction: Femoral neck fractures in the elderly are increasingly common as a result of a growing geriatric population with 1-year mortality rates approaching 35%. While preoperative medical optimization and early time to surgery have reduced morbidity and mortality, patients with numerous medical comorbidities remain high risk for death in the perioperative period. Identifying those with greatest risk with a scoring system or nomogram may assist multidisciplinary teams in reducing mortality following hemiarthroplasty. Purpose: Identify predictors of 30-day mortality in elderly patients who underwent hemiarthroplasty for a femoral neck fracture to generate a predictive nomogram to determine the probability of post-operative mortality. Methods: Retrospective evaluation using data from the ACS-NSQIP database from 2005 to 2014 with CPT code 27125 for hip hemiarthroplasty. Multiple factors including demographics and comorbidities were compared in patients who experienced 30-day mortality and those who did not. T-test and chi-square tests were used to analyze data and a multivariate model was generated using logistic regression. Results: Advanced age (odds ratio (OR) 1.04), underweight BMI (OR 1.55), male sex (OR 1.80), reduced functional status (OR 2.04), heart failure within 30 days prior to surgery (OR 2.22), American Society of Anesthesiologists grade > 2 (OR > 2.50), disseminated cancer (OR 3.43) were all found to have statistically significant odds ratios for 30-day mortality following hemiarthroplasty. Conclusion: A tool based on easily identifiable risk factors, demographics, and comorbidities was developed that can help predict elderly patients who will experience mortality within 30 days of following hemiarthroplasty. In addition to identifying high risk patients, the nomogram can serve as a counseling tool for physicians to use with patients and their families to assist with better understanding of perioperative mortality risk.

Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study

“…According to our experience, CAR would be a valuable prognostic factor when considering 30-day mortality after a traumatic hip fracture considering that it provides information on the inflammatory and nutritional status of the patients [ 17 , 23 ]. Ranzani et al [ 17 ], reported that CAR is a better predictive marker for 90-day mortality than CRP alone in patients with severe sepsis or septic shock.…”

“…In addition, high levels of CAR have been associated with increased in-hospital mortality, and with an increased 30-day mortality rate in general surgery, and critically ill patients [ 20 , 21 ]. Moreover, high CAR levels have been successfully used as a reliable predictor of mortality in different oncologic settings [ 22 , 23 ]. In patients affected by pancreatic cancer, CAR is currently used as an independent factor of poor long-term prognosis after surgical resection [ 22 , 35 ], and a valuable predictor for advancement in non-operable pancreatic cancer [ 36 ].…”

“…In patients affected by pancreatic cancer, CAR is currently used as an independent factor of poor long-term prognosis after surgical resection [ 22 , 35 ], and a valuable predictor for advancement in non-operable pancreatic cancer [ 36 ]. Similarly, CAR is a more reliable predictor of mortality than other serum markers in patients affected by lung cancer [ 37 ], in small lung cell cancer, non-small lung cell cancer, and adenocarcinoma [ 23 , 38 , 39 , 40 ].…”

“…To date, only a few studies have examined the predictive models for 30-day mortality after hip fractures [ 22 , 23 ], however, to the best of our knowledge, the use of CAR as a predictive marker has not been thoroughly investigated [ 24 , 25 ]. The aim of this study was to establish if an association exists between high levels of CAR and 30-day mortality after hip fractures.…”

A New Nomogram Model for Predicting 1-Year All-Cause Mortality After Hip Arthroplasty in Nonagenarians With Hip Fractures: A 20-Year Period Retrospective Cohort Study

“…Comorbidities are common in the elderly with hip fractures. Patients with three or more comorbidities or a complex medical history have significantly increased mortality compared with those with no comorbidities ( 14 , 15 ). Multiple comorbidities often co-exist and interact with each other.…”