Predictors of 30-day mortality in orthogeriatric fracture patients aged 85 years or above admitted from the emergency department

Schuijt, Henk Jan; Bos, J. A. H.; Smeeing, Diederik P.J.; Geraghty, Olivia; Velde, Detlef van der

doi:10.1007/s00068-019-01278-z

Cited by 9 publications

(16 citation statements)

References 28 publications

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“…Age per year and male gender are both reported as significant influencers of higher mortality in general-and hip Fig. 2 Survival curves, respectively, stratified for depression, sarcopenia, frequent falling, LOS, care level and place of residence fractured orthogeriatric patient cohorts [4][5][6]. As age was also a relevant influential factor in this investigation, we have just seen an insignificant tendency of higher male mortality.…”

Section: Discussionmentioning

confidence: 54%

“…The emphasis was set on the fracture-independent influence and predictive value of The majority of studies that have researched mortality associated risk factors in the orthogeriatric field examined hip fracture cohorts. Rarely a study examines diverse injuries [6]. Having included a follow-up rate of 661 patients the cohort can be seen as adequate for a relevant analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Having included a follow-up rate of 661 patients the cohort can be seen as adequate for a relevant analysis. Folbert et al and Schuijt et al who investigated in according questions had similar cohort strengths [ 5 , 6 ]. Before comparison to literature is performed, it has again to be taken into account that all patients in this study underwent orthogeriatric treatment and did suffer from a variety of injuries and not one specific fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Since the implementation of co-managed orthogeriatric treatment there is plenty evidence showing improved associated outcome for patients suffering from fragility fractures, especially hip fractures [3][4][5]. Rarely studies analyze more diverse cohorts of orthogeriatric patients that suffer from different or multiple injuries [6,7]. Several assessment and outcome parameters were evaluated and confirmed as "a standard set" in the scholar examination of orthogeriatric co-management of hip fractures [8].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up

Wiedl

Förch

Fenwick

et al. 2021

Eur J Trauma Emerg Surg

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Introduction Since the arise of orthogeriatric co-management patients’ outcome and survival has improved. There are several assessment parameters that screen the precondition of orthogeriatric patients including mobility, activities of daily living, comorbidities, place of residence and need for care just to name a few. In a 2-year follow-up on an orthogeriatric co-managed ward the fracture-independent predictive value of typical assessment parameters and comorbidities on the associated mortality was examined. Methods All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included. No fracture entity was preferred. Emphasis was set on following parameters: age, gender, Parker-Mobility Score (PMS), Barthel Index (BI), Charlson-Comorbidity Index (CCI), dementia, depression, sarcopenia, frequent falling, length of stay (LOS), care level (CL) and place of residence (POR). In a 2-year follow-up the patients’ death rates were acquired. SPSS (IBM Corp., Armonk, New York, USA) and Cox regression was used to univariately analyze the expression of the mentioned parameters and mortality course over 2 years from discharge. In a multivariate analysis intercorrelations and independent relationships were examined. Results A follow-up rate of 79.6% by assessing 661 patients was achieved. In the univariate analysis linear inverse correlation between PMS and BI and mortality and a linear positive correlation between CCI and higher mortality were observed. There was also a significant relationship between lower survival and age, dementia, sarcopenia, frequent falling, higher institutionalized place of residence and higher CL. No univariate correlation between 2-year mortality and gender, depression and LOS was found. In the multivariate Cox regression, the only independent risk factors remaining were lower PMS (HR: 1.81; 95%CI: 1.373–2.397), lower BI (HR: 1.64; 95%CI: 1.180–2.290) and higher age per year (HR: 1.04; 95%CI: 1.004–1.067). Conclusion Age, PMS, BI, CCI, preexisting dementia, sarcopenia, frequent falling, POR and CL are univariate predictors of survival in the orthogeriatric context. An independency could only be found for PMS, BI and age in our multivariate model. This underlines the importance of preexisting mobility and capability of self-support for the patient’s outcome in terms of survival.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up

Wiedl

Förch

Fenwick

et al. 2021

Eur J Trauma Emerg Surg

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“…Several risk factors are identified with higher mortality risk after a hip fracture. These include older age, American Society of Anesthesiologists (ASA) physical status classification, male sex and decreased body mass index 9. In addition, multiple comorbidities further increase the mortality after hip fracture surgery 10.…”

Section: Introductionmentioning

confidence: 99%

Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study

et al. 2022

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ObjectiveThe objective of this study was to explore the experiences from the period after the choice was made for palliative, non-operative management for geriatric patients with a hip fracture, to the most important factors in the process, as reported by a proxy.DesignSemistructured interviews were conducted between 1 August 2020 and 1 April 2021 to investigate by-proxy reported patient experiences of non-operative management after hip fracture. Interviews followed a topic guide, recorded and transcribed per word. Thematic analysis was used to identify themes in the data.Setting and participantsPatients were retrospectively identified from the electronic patient record. Relatives (proxies) of the patients who underwent palliative, non-operative management were contacted and were asked to participate in a semistructured interview and were named participants. The participants were proxies of the patients since patients were expected to be deceased during the timing of the interview.ResultsA total of 26 patients were considered eligible for inclusion in this study. The median age of the patients was 88 years (IQR 83–94). The 90-day mortality rate was 92.3%, with a median palliative care period of 11 days (IQR 4–26). A total of 19 participants were subjected to the interview. After thematic analysis, four recurring themes were identified: (1) the decision-making process, (2) pain experience, (3) patient–relative interaction and (4) the active dying.ConclusionsWith the introduction of shared decision-making in an acute setting for geriatric patients with hip fracture, proxies reported palliative, non-operative management as an acceptable and adequate option for patients with high risk of adverse outcomes after surgery. The emerged themes in palliative care for patients with hip fracture show great similarity with severe end-stage disease palliative care, with pain identified as the most important factor influencing comfort of the patient and their environment after hip fracture. Future research should focus on further improving targeted analgesia for these patients focusing on acute pain caused by the fracture.

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Development and internal validation of a clinical prediction model using machine learning algorithms for 90 day and 2 year mortality in femoral neck fracture patients aged 65 years or above

Oosterhoff

Savelberg

Karhade

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Preoperative prediction of mortality in femoral neck fracture patients aged 65 years or above may be valuable in the treatment decision-making. A preoperative clinical prediction model can aid surgeons and patients in the shared decision-making process, and optimize care for elderly femoral neck fracture patients. This study aimed to develop and internally validate a clinical prediction model using machine learning (ML) algorithms for 90 day and 2 year mortality in femoral neck fracture patients aged 65 years or above. Methods A retrospective cohort study at two trauma level I centers and three (non-level I) community hospitals was conducted to identify patients undergoing surgical fixation for a femoral neck fracture. Five different ML algorithms were developed and internally validated and assessed by discrimination, calibration, Brier score and decision curve analysis. Results In total, 2478 patients were included with 90 day and 2 year mortality rates of 9.1% (n = 225) and 23.5% (n = 582) respectively. The models included patient characteristics, comorbidities and laboratory values. The stochastic gradient boosting algorithm had the best performance for 90 day mortality prediction, with good discrimination (c-statistic = 0.74), calibration (intercept = − 0.05, slope = 1.11) and Brier score (0.078). The elastic-net penalized logistic regression algorithm had the best performance for 2 year mortality prediction, with good discrimination (c-statistic = 0.70), calibration (intercept = − 0.03, slope = 0.89) and Brier score (0.16). The models were incorporated into a freely available web-based application, including individual patient explanations for interpretation of the model to understand the reasoning how the model made a certain prediction: https://sorg-apps.shinyapps.io/hipfracturemortality/ Conclusions The clinical prediction models show promise in estimating mortality prediction in elderly femoral neck fracture patients. External and prospective validation of the models may improve surgeon ability when faced with the treatment decision-making. Level of evidence Prognostic Level II.

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Predictors of 30-day mortality in orthogeriatric fracture patients aged 85 years or above admitted from the emergency department

Cited by 9 publications

References 28 publications

Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up

Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up

Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study

Development and internal validation of a clinical prediction model using machine learning algorithms for 90 day and 2 year mortality in femoral neck fracture patients aged 65 years or above

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