Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture

Novoa-Parra, C.D.; Hurtado-Cerezo, J.; Morales-Rodríguez, J.; Sanjuán-Cerveró, Rafael; Rodrigo-Pérez, J.L.; Lizaur-Utrilla, Alejandro

doi:10.1016/j.recote.2019.03.005

Cited by 6 publications

(5 citation statements)

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“…Patients with an increased risk of mortality after 30 days were found to be older, male, or have an underweight BMI. These results are similar to studies published by Major and North, and Novoa-Parra et al 11 , 18 While age and gender are non-modifiable risk factors, underweight BMI can be targeted post-operatively to improve nutritional status and possibly reduce mortality. 19 , 20 While these findings did not contribute to the development of the nomogram, data from the NSQIP database demonstrated that patients with a reduced serum albumin had an increased risk of mortality (3.3 g/dL vs. 3.5 g/dL, P < 0.0001).…”

Section: Discussionsupporting

confidence: 90%

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

Crawford

Southam

Matar

et al. 2020

Geriatr Orthop Surg Rehabil

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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.

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Section: Discussionsupporting

confidence: 90%

“…Male gender, age > 80, non-ambulatory status, and American Society of Anesthesiologists (ASA) grade 4 or 5 have been shown to be predictors of mortality in patients with femoral neck fractures. 11 , 18 Additionally, patients with 3 or more comorbidities, respiratory disease, or malignancy were more likely to experience death. 10 …”

Section: Introductionmentioning

confidence: 99%

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

Crawford

Southam

Matar

et al. 2020

Geriatr Orthop Surg Rehabil

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“…Various studies have evaluated the risk of death based on the ASA classi cation, reporting that those with ASA-III or -IV had a higher risk of death compared to ASA-I or -II [19,20]. According to the National Hip Fracture Registry (RNFC), in 2017 more than 70% of patients had a high anaesthetic risk (ASA III-IV) [9].…”

Section: Discussionmentioning

confidence: 99%

Influence of Orthogeriatrics on the Morbidity and Mortality of Patients with Hip Fracture.

Balvís-Balvís¹,

Domínguez-Prado²,

Ferradas-Garcia³

et al. 2020

Preprint

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BACKGROUND: Osteoporotic hip fractures often occur in fragile, elderly patients and are associated with a significant morbidity and mortality. The objective of this study is to evaluate the morbidity and mortality together with the length of hospital stay in patients with hip fracture in two non-consecutive years and to compare their evolution with the involvement of a specialist in orthogeriatric care.MATERIAL AND METHODS: Retrospective study that reviewed a total of 633 patients with an average age of 85.5 years who suffered a hip fracture and were treated in the same service of Trauma and Orthopaedics in two different years (2012 and 2017). We have analysed mortality, morbidity during their hospital stay, the length of hospital stays and the cost-benefit after the implication of a specialist in orthogeriatric care in 2017.RESULTS: Mortality during their hospital stay decreased significantly from 10% in 2012 to 3.6% in 2017. We have also observed a decrease in mortality at 30 days (10.5% versus 7%) and after one year (28.9% versus 24.9%) between both groups, although these differences were not statistically significant. The length of hospital stays decreased significantly between both periods observed. The average stay decreased by 4.8 days, the surgical delay decreased by 1.1 days and the postoperative hospital stay decreased by 3.4 days. The total annual economic savings estimated due to the involvement of a geriatrician in the follow-up of patients with hip fracture was 1,017.084.94€.CONCLUSIONS: The multidisciplinary approach of patients with hip fracture results in a more effective and more efficient care model. The quality of care and the clinical care optimisation of patients in the perioperative period improve and both hospital stay and mortality during hospital stay decrease significantly. A significant economic saving is also obtained in the treatment of this pathology.

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“…Hip-OPERA showed acceptable discrimination for 1-year mortality and institutional residence at 120 days as it contains variables associated with these outcomes. 13,14,39,40 Physical health, function, and independence are key priorities for older femur fracture patients. 41 Missingness of data was investigated and dealt with using imputation.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Validation and updating of the Older Person’s Emergency Risk Assessment (OPERA) score to predict outcomes for hip fracture patients

2023

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Introduction: Hip fractures are associated with significant morbidity and mortality in older people. Accurate risk stratification is important for planning of care, informed decision-making and communication with patients and relatives. The Older Persons’ Emergency Risk Assessment (OPERA) score is a risk stratification score for older people admitted to hospital. Our aims were to validate OPERA in hip fracture patients, update the score and compare performance with the Nottingham Hip Fracture Score (NHFS). Methods: This dual-centre 3-year observational study (2016–2018) included acutely admitted hip fracture patients managed surgically aged ⩾65 years. The primary outcome was 30-day mortality. Secondary outcomes included residence at 120 days and 1-year mortality. Model performance was assessed using area under the curve (AUC) analysis and Brier scores (discrimination) and calibration curves. The OPERA score was updated using regression analysis with additional independent predictors and validated using bootstrap analysis. Results: 2142 patients (median age 86 [80–91] years) were included with a 30-day mortality of 5.2% and a 1-year mortality of 31.4%. 30-day mortality AUC for OPERA was 0.75 (95% CI, 0.73–0.77) and for NHFS 0.68 (0.65–0.70). For 1-year mortality AUC for OPERA was 0.74 (0.73–0.75) and for NHFS 0.70 (0.69–0.71). The OPERA Score was updated to Hip-OPERA, including ASA grade. Hip-OPERA demonstrated an AUC for 30-day mortality of 0.77 (0.73–0.81) and an AUC for 1-year mortality of 0.76 (0.75–0.77). AUC for new residential care status at 120 days was 0.79 (0.78–0.80). Conclusions: Hip-OPERA demonstrated superior discrimination to the NHFS and OPERA for 30-day mortality, 1-year mortality and residence at 120 days following hip fracture. External validation is desirable.

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Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture

Cited by 6 publications

References 20 publications

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

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

Influence of Orthogeriatrics on the Morbidity and Mortality of Patients with Hip Fracture.

Validation and updating of the Older Person’s Emergency Risk Assessment (OPERA) score to predict outcomes for hip fracture patients

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