Charlson Comorbidity Index Predicts 5-Year Survivorship of Surgically Treated Hip Fracture Patients

Abstract

Introduction:This study aims to assess the correlation of the age-adjusted Charlson comorbidity index (ACCI) with 5-year mortality in a surgically treated hip fracture population.Materials and Methods:A retrospective analysis was performed on 1057 patients aged 60 years and above who underwent surgery for hip fracture with a minimum of 5-year follow-up (92.2% 5-year follow-up rate) in a tertiary hospital. Manual review of patients’ electronic hospital records was performed to record demographic data, comorbidities, and length of stay. Mortality data were extracted from the hospital’s electronic medical records and corroborated with the National Electronic Health Record.Results:Of the 1057 patients, 283 (26.8%) were male. The majority of patients were 80 years of age and above (42.5%), with the oldest patient operated on age 102 with a mean age of 77.8 (8.6) years. Four hundred eighteen (39.5%) patients sustained extracapsular intertrochanteric fractures. The mean follow-up duration was 8 years and 3 days with an overall survivorship of 37.2%. A multiple regression model constructed with ACCI, age, gender, and fracture pattern demonstrated satisfactory predictive ability with a concordance statistic of 0.68. Patients with a higher ACCI category (≥6) had an increased 5-year mortality rate (41.8%) with an odds ratio of 13.6 (6.7-31.8, P < .001) compared to those with an ACCI category of 3 and below (89.3%).Discussion:The study demonstrates that ACCI correlated with 5-year mortality after surgical treatment of hip fracture. This information is pertinent in the counseling of patients with regard to their midterm survival following hip fracture surgery and may inform policy makers of the varied midterm survival rates in patients with differing ACCI scores and educate the allocation of health-care resources.Conclusion:The ACCI correlates with 5-year mortality after surgical treatment of hip fracture.

Elevated 1-Year Mortality Rate in Males Sustaining Low-Energy Proximal Femur Fractures and Subgroup Analysis Utilizing Age-Adjusted Charlson Comorbidity Index

“…These findings are consistent with a prior study using a similar ACCI model finding increased mortality rates at 1 year for both males and patients with increased ACCI. 5 When examining our findings in comparison to the multiple comorbidities found to be significantly more common in males presenting with lowenergy hip fractures, it suggests that a decreased overall health status possibly predisposes these men to sustaining the fractures, as well their ability to recover from the injury.…”

“…Studies grounded in orthopedics, as well as across the medical field, have utilized variations in comorbidity calculators and frailty indices to evaluate for association between health status and mortality rates. [5][6][7][8][9] We aim to further delineate the role specific patient characteristics play in mortality rates after sustaining a pathologic fracture of the hip secondary to osteoporosis.…”

“…Extensive evidence exists regarding the impact of lowenergy proximal femur fractures on patient mortality. 5,6,[10][11][12] Continued investigation into femur fracture location, gender, and associated patient characteristics and their role in mortality are required to provide the most accurate information for patients and families. Our primary investigation is to evaluate for a gender difference in 1-year mortality after sustaining a low-energy proximal femur fracture.…”

Sociodemographic and clinical correlates of diabetes self‐efficacy in adults with type 2 diabetes and comorbid heart failure

“…The CCI was first developed and validated to evaluate the risk of death and burden of disease (Charlson, Pompei, Ales, & MacKenzie, ; Charlson, Szatrowski, Peterson, & Gold, ). It has been widely used in clinical research to manage the confounding influence of comorbidities to standardize comorbidities extracted from medical records, administrative databases, or self‐report and to predict outcomes (Charlson, Wells, Ullman, King, & Shmukler, ; Frenkel, Jongerius, Uitert, Munster, & Rooij, ; Jiang et al, ; Neuhaus, King, Hageman, & Ring, ). The weighted index of comorbidity was computed using the Charlson and colleagues' () assigned weight for specific diseases.…”

Association between the Charlson comorbidity index and outcomes after implantable cardioverter defibrillator generator replacement

“…We sought to investigate the correlation between the Charlson comorbidity index (CCI) and outcomes of appropriate ICD therapy and mortality following ICD generator replacement . The CCI is a well‐validated measure of comorbidity burden that is predictive of mortality in a number of cardiac and noncardiac conditions …”