Prognostic nomogram for risk of mortality after hip fracture surgery in geriatrics

Abstract

Hip fracture is a significant public health problem, with associated high morbidity and mortality. Orthopedic surgeons are concerned to improve prognosis and stratify mortality risk after hip fracture surgery. This study established a nomogram that combines the Charlson Comorbidity Index (CCI) with specific laboratory parameters to predict mortality risk after hip fracture surgery in geriatrics. Methods: The records of consecutive patients who underwent hip fracture surgery from January 2015 through May 2020 at one medical center were reviewed for perioperative factors and mortality. Patients with age ≥ 70 years who were diagnosed with intertrochanteric or femoral neck fractures were included. Patients who were diagnosed with pathological fracture, received only conservative treatment or lost to follow-up were excluded. A multivariate Cox proportional hazards regression model was used to identify risk factors. A nomogram was established with R software and evaluated using concordance (C)-index, area under receiver operating characteristic (AUC), calibration curves, and decision curve analysis (DCA). Results: In total, 454 patients were included with a mean age of 81.6 years. The mean follow-up and oneyear mortality rate were 37.2 months and 10.4%, respectively. Five identified risk variables for mortality after hip fracture surgery in geriatrics comprised age (HR 1.05, 95% CI 1.01-1.08; P = 0.003), CCI (HR 1.38, 95% CI 1.24-1.54; P = 0.0 0 0), albumin (HR 1.78, 95% CI 1.31-2.43; P = 0.0 0 0), sodium (HR 1.59, 95% CI 1.18-2.15; P = 0.002) and hemoglobin (HR 1.46, 95% CI 1.07-2.00; P = 0.02). A nomogram was proposed and evaluated, showing a C-index of 0.76 ± 0.02. The AUCs for 6-month, 1-year, and 3-year mortality predictions were 0.83, 0.79, and 0.77, respectively. The calibration curve and DCA showed good discrimination and clinical usefulness. Conclusion: This novel nomogram for stratifying the mortality risk after hip fracture surgery in geriatrics incorporated age, CCI, serum albumin, sodium, and hemoglobin. Internal validation indicated that the model has good accuracy and usefulness. This nomogram had improved convenience and precision compared with other models. External validation is warranted to confirm its performance.

Predictive model for prolonged length of hospital stay in patients with osteoporotic femoral neck fracture: A 5-year retrospective study

“…The causes of death were related to co-morbidities and postoperative complications ( 6 ). More recent data has indicated that the mortality rate of this type of fracture has declined to around 10% ( 7 ). One of the factors associated with the high mortality rates with this type of fracture is the length of stay (LOS).…”

Age-adjusted Charlson comorbidity index predicts postoperative mortality in elderly patients with hip fracture: A prospective cohort

“…The results demonstrated that patients with aCCI ≥ 6 had an increased 5-year mortality rate with an odds ratio of 13.6 compared to those with aCCI ≤ 3. Moreover, a study by Gatot et al (34) concluded that an aCCI ≥ 6 could (8). The sample size in our study was also larger than those used in these previous studies (8,24,25,33,35).…”

“…Moreover, a study by Gatot et al (34) concluded that an aCCI ≥ 6 could (8). The sample size in our study was also larger than those used in these previous studies (8,24,25,33,35).…”

A New Nomogram Model for Predicting 1-Year All-Cause Mortality After Hip Arthroplasty in Nonagenarians With Hip Fractures: A 20-Year Period Retrospective Cohort Study

“…Both aCCI and ASA classification are common tools for operative risk stratification. Previous studies have attempted to use CCI and ASA for risk stratification and suggested that CCI performed better than ASA classification in the prediction for 1-year mortality after surgery for hip fractures ( 17 , 18 ). However, some studies suggested that ASA classification was an independent risk factor for it, rather than CCI ( 19 ).…”