Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients

Burgos, Eva Cuchi; Gómez-Arnau, J; Díez, Rosa; Muñoz, L Fernández; Fernández-Guisasola, J; García-del-Valle, Santiago

doi:10.1111/j.1399-6576.2007.01473.x

Cited by 80 publications

(75 citation statements)

References 41 publications

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“…Our analysis of outcome in the different risk bands revealed that calibration was poor independent of method to predict mortality. Moreover, ROC analysis in the present study suggests poor discrimination and is very similar to the area under ROC curve reported for hip fracture patients in previous studies (0.62‐0.68)9, 12, 13 with the exception of a single study reporting an area under the ROC curve of 0.83 14. As suggested above, a potential explanation for the differing results in the studies targeting hip fracture patients is the method used to calculate risk bands.…”

Section: Discussionsupporting

confidence: 88%

“…The Physiological and Operative Severity Score for the enUmeration of mortality and morbidity (POSSUM) score is a commonly used scoring system for perioperative risks which takes into account both the preoperative physiological status and the characteristics of the surgical procedure 8. The POSSUM score has been investigated in hip fracture patients in a number of studies with variable results with regard to calibration and discrimination 9, 10, 11, 12, 13, 14. Performance in a Scandinavian setting is unknown.…”

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: 88%

Section: Introductionmentioning

confidence: 99%

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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“…Different tools to estimate perioperative risk of elderly patients with hip fractures [11] have been described. For our model, we conducted a literature review using PubMed searching the terms ''hip fracture mortality risk prediction'', and identified studies which specifically described two critical factors: (1) odds ratio (OR) of mortality as a function of risk stratification, and (2) change in length of stay as a function of risk stratification.…”

Section: Risk Stratificationmentioning

confidence: 99%

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Swart

Vasudeva

Makhni

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program. Questions/Purposes We performed an economic analysis to determine whether implementation of a comanagement model of care for geriatric patients with osteoporotic hip fractures would be a cost-effective intervention at hospitals with moderate volume. We also calculated what annual volume of cases would be needed for a comanagement program to ''break even'', and finally we evaluated whether universal or risk-stratified comanagement was more cost effective. Methods Decision analysis techniques were used to model the effect of implementing a systems-based strategy to improve inpatient perioperative care. Costs were obtained from best-available literature and included salary to support personnel and resources to expedite time to the operating room. The major economic benefit was decreased initial hospital length of stay, which was determined via literature review and meta-analysis, and a health benefit was improvement in perioperative mortality owing to expedited preoperative evaluation based on previously conducted meta-analyses. A break-even analysis was conducted to determine the annual case volume necessary for comanagement to be either (1) cost effective (improve health-related quality of life enough to be worth additional expenses) or (2) result in cost savings (actually result in decreased total expenses). This calculation assumed the scenario in which a hospital could hire only one hospitalist (and therapist and social worker) on a full-time basis. Additionally, we evaluated the scenario where the necessary staff was already employed at the hospital and could be dedicated to a comanagement service on a part-time basis, and explored the effect of triaging only patients considered high risk to a comanagement service versus comanaging all geriatric patients. Finally, probabilistic sensitivity analysis was conducted on all critical variables, with broad ranges used for values around which there was higher uncertainty. Results For the base case, universal comanagement was more cost effective than traditional care and risk-stratified comanagement (incremental cost effectiveness ratios of All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity...

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“…There is some controversy between the value of the ASA grade and predicting mortality in the literature [5] [13] [14]. Some authors support the link between ASA score and mortality [15]- [20] The Donati score is a non-specific general surgical and orthopaedic 4-item score using age range, ASA, surgical severity, and urgency of surgery to calculate mortality risk.…”

Section: Discussionmentioning

confidence: 99%

A Simple Classification System for Hip Fractures

Elsorafy¹,

Machaurab²,

Kamal³

et al. 2014

OJO

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Background: We have developed a Hip Fracture Classification which stratifies patients into 4 groups upon admission according to fracture complexity. This classification considers pathoanatomic and physiologic parameters and was developed to help identify high-risk patients, with more surgical demands and consequently higher incidence of morbidity. Materials and Methods: Data was gathered prospectively for a cohort of 273 consecutive patients admitted over a 12-month period between 2008 and 2009 and classified according to the Hip Fracture Complexity Classification (C0 -C3). The following outcome measures (mortality and length of hospital stay) were reviewed at thirty days and one year. Result: The overall mortality was 4.4% at 30 days and 20% at 1 year. There were significant differences in 1-year mortality between all stratified groups (P < 0.001), but not at 30-days. No difference in length of hospital stay was noted between complexity groups (P = 0.4). Conclusion: Clinical complexity is a significant factor influencing patient outcomes following hip fractures. Our classification helps highlight patients with higher surgical demands, aiming to draw more resources and help with optimization of care to those candidates. We believe such a system could be used to evaluate different hospitals performance more accurately. Since, national data is published annually; this system can help correlate morbidity and mortality with clinical complexity.

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Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients

Abstract: A simple index such as the RISK-VAS scale was the best predictor of serious post-operative complications. The functional level before the fracture, measured with the Barthel index, had a major influence on the ambulation recovery.

Cited by 80 publications

References 41 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

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

A Simple Classification System for Hip Fractures

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