Abstract
PurposeThe post-operative mortality after hip fracture surgery is high and has remained largely unchanged during the last decades. The Revised Cardiac Risk Index (RCRI) is a tool used to evaluate the 30-day risk of, among other outcomes, post-operative mortality. The aim of this study is to determine the association between the RCRI score and post-operative mortality in patients undergoing hip fracture surgery.MethodsData was obtained from the national hip fracture register which was cross-referenced with patients’ electronic hospital records. All adults who underwent primary emergency hip fracture surgery in Orebro County, Sweden, between January 1, 2013 and December 31, 2017, were included. Patients were divided into two cohorts: low RCRI (score = 0–1) and high RCRI (score ≥ 2). A Poisson regression model was employed to investigate the association between a high RCRI score and 30- and 90-day post-operative mortality.ResultsA total of 2443 patients, of whom 446 (18%) had a high RCRI score, were included in the current study. When adjusting for age, sex, comorbidities and type of surgery, the incidence of 30-day mortality increased by 46% in the high RCRI cohort (adj. IRR 1.46, 95% CI, 1.10–1.94, p = 0.010). Similar results were observed for 90-day mortality (adj. IRR 1.50, 95% CI, 1.21–1.84, p < 0.001).ConclusionThe RCRI is applicable to patients that undergo surgery for traumatic hip fractures. A high RCRI score is associated with an increased incidence of both 30- and 90-day post-operative mortality. Future studies to evaluate these findings are needed.
Highlights
Materials and methodsHip fractures are a common injury in the elderly
The high Revised Cardiac Risk Index (RCRI) cohort was older (mean age: 83.7 (SD 8.4) vs 81.5 (SD 10.2) years, p < 0.001), had more comorbidities (CCI ≥ 7: 77.5% vs. 19.6%, p < 0.001), and was less fit for surgery based on their American Society of Anesthesiologists classification (ASA ≥ 3: 82.0% vs. 44.1%, p < 0.001) (Table 1)
The low RCRI cohort was managed with more advanced surgical techniques, such as total hip replacement and hemiarthroplasty, while the high RCRI cohort was subjected to less invasive surgical methods (Table 1)
Summary
Materials and methodsHip fractures are a common injury in the elderly. As the global population continues to age, the incidence of hip fractures is predicted to increase [1]. There are few tools that are easy to use in clinical practice when trying to predict mortality rates after hip fracture surgery. Previous studies have suggested using tools such as the Possum Score, the Charlson Comorbidity Index, or the 5-factor modified frailty index [4,5,6] These indices are complex or have inherent limitations which restrict their clinical utility; the Possum score has 18 variables, some of which are collected in the intra- or post-operative period [7], the Charlson Comorbidity Index has 17 variables [8], and the 5-factor modified frailty index includes functional status which is subjective and may be difficult to assess in the emergency setting [6]. Clinical decisions are made based on individual cases by the treating physician, predictive tools offer the benefit of facilitating resource allocation on a group level and they support physicians in objective decision-making as well as in communication with patients and family members
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