Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery

Maxwell, Melanie; Moran, C.G.; Moppett, I. K.

doi:10.1093/bja/aen236

Cited by 304 publications

(370 citation statements)

References 24 publications

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“…Our result of an area under the ROC curve of 0.67 is within the range of 0.64‐0.77 reported in previous studies12, 19, 21, 23, 32 and suggests an equally poor discrimination for POSSUM and the NHFS in our cohort. Interestingly, while some studies have demonstrated superior discrimination by scores specifically designed for hip fracture patients12 compared to that of general surgical risk scores several other studies have not been able to demonstrate such a difference 19, 32. Our results align with the latter studies and illustrate the importance of external validation of risk prediction scores.…”

Section: Discussionsupporting

confidence: 86%

“…The NHFS was developed in response to reports of poor performance of POSSUM in hip fracture patient 9, 19. Our result of an area under the ROC curve of 0.67 is within the range of 0.64‐0.77 reported in previous studies12, 19, 21, 23, 32 and suggests an equally poor discrimination for POSSUM and the NHFS in our cohort.…”

Section: Discussionsupporting

confidence: 74%

“…Because the Short Portable Mental Status Questionnaire (SPMSQ) was established at our institution we choose to adjust the score and use a SPMSQ of ≤6 out of 10 as the definition of cognitive impairment 27. For all other variables, definitions and cut‐offs as described in the derivation of the score were used 19. Estimation of 30‐day mortality risk was performed using the modified equation from 2012 20…”

Section: Methodsmentioning

confidence: 99%

“…The Nottingham Hip Fracture Score (NHFS) is specifically designed for risk prediction in elderly hip fracture patients 19, 20. It is somewhat simpler than the POSSUM and P‐POSSUM scores and does not require insertion of operative data, and is thus more suited to preoperative risk evaluation.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Jonsson

Bentzer

Turkiewicz

et al. 2018

Acta Anaesthesiol Scand

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BackgroundLittle is known about accuracy of common risk prediction scores in elderly patients suffering from hip fractures. The objective of this study was to investigate accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score, Portsmouth‐POSSUM (P‐POSSUM) score and the Nottingham Hip Fracture Score (NHFS) for prediction of mortality and morbidity in this patient group.MethodsThis was a prospective single centre observational study on 997 patients suffering out‐of‐hospital cervical, trochanteric or subtrochanteric fracture of the neck of the femur. Calibration and discrimination was assessed by calculating the ratio of observed to expected events (O:E) and areas under receiver operating characteristics curves (ROC).ResultsThe 30‐day mortality was 6.2% and complications, as defined by POSSUM, occurred in 41% of the patients. Overall O:E ratios for POSSUM, P‐POSSUM and NHFS scores for 30‐day mortality were 0.90, 0.98, and 0.79 respectively. The models underestimated mortality in the lower risk bands and overestimated mortality in the higher risk bands. In contrast, POSSUM predicted morbidity well with O:E ratios close to unity in most risk bands. The areas under the ROC curves for the scoring systems was 0.60‐0.67.ConclusionThe POSSUM score and NHFS show moderate calibration and poor discrimination in this cohort. The results suggest that mortality and morbidity in hip fracture patients are largely dependent on factors that are not included in these scores.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Jonsson

Bentzer

Turkiewicz

et al. 2018

Acta Anaesthesiol Scand

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“…Predicted mortality after fractured neck of femur fracture nationally is measured at 20–35% 1–3 . The mortality for fractured neck of femur can be measured using previously published scoring systems (eg Nottingham Hip Fracture Score [NHFS]) 4 but these can be cumbersome and sometimes impractical when deciding on patient management. A simpler solution would be to use biochemical markers measured routinely on admission.…”

mentioning

confidence: 99%

Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur

Kieffer

Rennie

Gandhe

2013

annals

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A simple measure to determine one-year mortality following hip fractures has its benefits. Where there is controversy over implant selection, such a scoring system can facilitate the decision-making process. We undertook a retrospective analysis of one-year postoperative mortality of our hip fracture patients and established their admission serum albumin levels to see if there was any correlation between this and one-year mortality. Our results showed one-year mortality was significantly higher (p=0.0049) for those patients with a serum albumin of <35g/dl. Of the patients with low albumin, we found that there was no statistical significance between one-year mortality and source of admission (p=0.0789). Prefracture serum albumin can be used as a simple predictor of one-year mortality in patients presenting with a fractured neck of femur, thereby aiding operative planning and implant selection with a view to likely survival and possible need for revision.

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Use of the Shizuoka Hip Fracture Prognostic Score (SHiPS) to Predict Long‐Term Mortality in Patients With Hip Fracture in Japan: A Cohort Study Using the Shizuoka Kokuho Database

Ohata¹,

Nakatani²,

Kaneda

et al. 2023

JBMR Plus

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Hip fractures are common in patients of advanced age and are associated with excess mortality. Rapid and accurate prediction of the prognosis using information that can be easily obtained before surgery would be advantageous to clinical management. We performed a population-based retrospective cohort study using an 8.5-year Japanese claims database (April 2012-September 2020) to develop and validate a predictive model for long-term mortality after hip fracture. The study included 43,529 patients (34,499 [79.3%] women) aged ≥65 years with first-onset hip fracture. During the observation period, 43% of the patients died. Cox regression analysis identified the following prognostic predictors: sex, age, fracture site, nursing care certification, and several comorbidities (any malignancy, renal disease, congestive heart failure, chronic pulmonary disease, liver disease, metastatic solid tumor, and deficiency anemia). We then developed a scoring system called the Shizuoka Hip Fracture Prognostic Score (SHiPS); this system was established by scoring based on each hazard ratio and classifying the degree of mortality risk into four categories based on decision tree analysis. The area under the receiver operating characteristic (ROC) curve (AUC) (95% confidence interval [CI]) of 1-year, 3-year, and 5-year mortality based on the SHiPS was 0.718 (95% CI, 0.706-0.729), 0.736 (95% CI, 0.728-0.745), and 0.758 (95% CI, 0.747-0.769), respectively, indicating good predictive performance of the SHiPS for as long as 5 years after fracture onset. Even when the SHiPS was individually applied to patients with or without surgery after fracture, the prediction performance by the AUC was >0.7. These results indicate that the SHiPS can predict long-term mortality using preoperative information regardless of whether surgery is performed after hip fracture.

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Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery

Abstract: We have developed and validated a scoring system that reliably predicts the probability of mortality at 30 days for patients after hip fracture.

Cited by 304 publications

References 24 publications

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden — A prospective observational study

Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur

Use of the Shizuoka Hip Fracture Prognostic Score (SHiPS) to Predict Long‐Term Mortality in Patients With Hip Fracture in Japan: A Cohort Study Using the Shizuoka Kokuho Database

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