Three preoperative scoring systems to predict 30-day mortality in elderly patients undergoing hip fracture surgery

Abstract

Objective To compare 3 kinds of preoperative scoring systems used to predict 30-day mortality in a hip fracture population, Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM), Portsmouth modified POSSUM (P-POSSUM) and Estimation of Physiologic Ability and Surgical Stress (E-PASS). Methods A retrospective study was conducted to analyze the aged 654 patients who had undergone surgery for femoral intertrochanteric fracture or femoral neck fracture from January 2010 through June 2014 at our hospital. They were 225 men and 429 women, 60 to 103 years of age (average, 71.7 years). There were 363 femoral intertrochanteric fractures and 291 femoral neck fractures. Closed reduction and intramedullary nailing was performed in 363 cases, artificial dipolar replacement in 242 cases, and total hip replacement in 49 cases. POSSUM, P-POSSUM and E-PASS scoring systems were used to predict the 30-day mortality. The discrepancy between the predictive risk and the actual observation was analyzed. Results Of the 654 patients, 25 died within 30 days after operation. According to POSSUM scoring system, the predictability (observed deaths/POSSUM deaths) was 0.30, showing a significant difference between the predictive deaths and the actual deaths (χ2=34.840,P=0.009). According to P-POSSUM and E-PASS scoring systems, the predictability was respectively 0.83 and 1.04, demonstrating no significant differences between the predictive deaths and the actual deaths (P>0.05). Conclusion P-POSSUM and E-PASS scoring systems may predict 30-day mortality more accurately than POSSUM scoring system in elderly patients undergoing hip fracture surgery. Key words: Hip fractures; Mortality; Score system; Aged