Abstract
This study evaluated the use of risk prediction models in estimating short- and mid-term mortality following proximal hip fracture in an elderly Austrian population. Data from 1101 patients who sustained a proximal hip fracture were retrospectively analyzed and applied to four models of interest: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), Charlson Comorbidity Index, Portsmouth-POSSUM and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) Risk Score. The performance of these models according to the risk prediction of short- and mid-term mortality was assessed with a receiver operating characteristic curve (ROC). The median age of participants was 83 years, and 69% were women. Six point one percent of patients were deceased by 30 days and 15.2% by 180 days postoperatively. There was no significant difference between the models; the ACS-NSQIP had the largest area under the receiver operating characteristic curve for within 30-day and 180-day mortality. Age, male gender, and hemoglobin (Hb) levels at admission <12.0 g/dL were identified as significant risk factors associated with a shorter time to death at 30 and 180 days postoperative (p < 0.001). Among the four scores, the ACS-NSQIP score could be best-suited clinically and showed the highest discriminative performance, although it was not specifically designed for the hip fracture population.
Highlights
The crude incidence of hip fractures in Austria per 100,000 inhabitants increased in women from 493 to 642 by 2005 and in men from 192 to 280 by 2006 [1]
This study evaluated the use of risk prediction models in estimating short- and mid-term mortality following proximal hip fracture in an elderly Austrian population
Data from 1101 patients who sustained a proximal hip fracture were retrospectively analyzed and applied to four models of interest: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), Charlson Comorbidity Index, Portsmouth-POSSUM and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) Risk Score. The performance of these models according to the risk prediction of short- and mid-term mortality was assessed with a receiver operating characteristic curve (ROC)
Summary
The crude incidence of hip fractures in Austria per 100,000 inhabitants increased in women from 493 to 642 by 2005 and in men from 192 to 280 by 2006 [1]. The mortality rates following hip fractures in elderly patients vary in the literature, from 2.8% to 12.1% for 30 days, and can range from 14% to 36% for one-year mortality, according to the literature [2,3]. Several orthopedic-related articles have applied the ACS-NSQIP surgical risk calculator to identify the preoperative risk factors that increase the risk of postoperative complications in patients; these. Several orthopedic-related articles have applied the ACS-NSQIP surgical risk calculator to identify the preoperative risk factors that increase the risk of postoperative complications in patients; these studies mostly focused on a single risk factor [5]. Edelstein et al evaluated the ab2iolfit1y2 of the surgical calculator to predict complications within 30 days in patients with total hip and knee arthroplasty [6] (Appendix Table A1). Diagnostics 2021, 11, 497 as inter- and subtrochanteric fractures were treated by internal fixation using short or long nails
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