Abstract
BackgroundEarly detection of a high-risk patient following hip fracture surgery is of paramount clinical importance. American Society of Anesthesiologists (ASA) grading is an easy and efficient index in predicting a worse outcome. The red cell distribution width (RDW) and handgrip strength, are gaining interest as a prediction tool as well. Accordingly, the objective of this study was to investigate the potential association between ASA, RDW and grip strength and detect the effects of combining RDW and grip strength for predicting early complication after hip fracture surgery in the elderly.MethodsEighty-three consecutive patients operated with hip fracture surgeries were identified retrospectively. Age, gender, diagnosis, RDW, handgrip strength and ASA grade were recorded. Admission to the intensive care unit (ICU), length of ICU stay, transfer to other departments, in-hospital death, and readmission were investigated as early complications. Logistic regression analysis was applied to evaluate the estimates in predicting complications, and receiver operating characteristics curves were constructed to compare the estimates and decide which method is more accurate.ResultsAfter the surgery, 52% of the patients were admitted to the ICU. From the analyses, RDW and grip strength had no significant relation with each other. However, the ICU stay was correlated with RDW and grip strength but not for the ASA grade. A higher ASA grade and grip strength could independently predict ICU admission. The combination of RDW with grip strength outweighed the ASA grade in predictive ability.ConclusionsThe current study indicated that combining RDW and grip strength measures can be efficient and clinically relevant in predicting early postoperative complications after fragility hip fracture in the elderly. Due to the objectivity and availability of those two approaches, patient care, and functional outcomes are expected to be improved by adopting these measures in the clinical setting.
Highlights
Detection of a high-risk patient following hip fracture surgery is of paramount clinical importance
Prediction of complications after hip fracture surgery in elderly subjects is of crucial importance in preventing adverse effects, as the patients are still vulnerable after the surgery
The American Society of Anesthesiologists (ASA) scoring system was utilized for estimating the patient’s physical suitability for surgery [10] and has been reported to be a strong predictor of complications related to the hip fracture operation and mortality [4, 6, 11,12,13]
Summary
Detection of a high-risk patient following hip fracture surgery is of paramount clinical importance. Pre-surgical evaluation tools such as the Charlson comorbidity index [7], the Nottingham Hip Fracture Score [8], and the orthopedic version of the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity [9] have been put together and provide accurate risk prediction and help in decision making and clinical planning. The American Society of Anesthesiologists (ASA) scoring system was utilized for estimating the patient’s physical suitability for surgery [10] and has been reported to be a strong predictor of complications related to the hip fracture operation and mortality [4, 6, 11,12,13]. It is true that the ASA scoring system’s reliability has been questioned among anesthesiologists from differing backgrounds [14]
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