Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Development of Prediction Model for 1-year Mortality after Hip Fracture Surgery

  • Konstantinos Alexiou (Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa) ;
  • Antonios A. Koutalos (Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa) ;
  • Sokratis Varitimidis (Department of Orthopaedic Surgery and Musculoskeletal Trauma, School of Health Sciences, Faculty of Medicine, University of Thessaly) ;
  • Theofilos Karachalios (Department of Orthopaedic Surgery and Musculoskeletal Trauma, School of Health Sciences, Faculty of Medicine, University of Thessaly) ;
  • Konstantinos N. Malizos (School of Health Sciences, Faculty of Medicine, University of Thessaly)
  • Received : 2023.06.28
  • Accepted : 2023.10.23
  • Published : 2024.06.01
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Abstract

Purpose: Hip fractures are associated with increased mortality. The identification of risk factors of mortality could improve patient care. The aim of the study was to identify risk factors of mortality after surgery for a hip fracture and construct a mortality model. Materials and Methods: A cohort study was conducted on patients with hip fractures at two institutions. Five hundred and ninety-seven patients with hip fractures that were treated in the tertiary hospital, and another 147 patients that were treated in a secondary hospital. The perioperative data were collected from medical charts and interviews. Functional Assessment Measure score, Short Form-12 and mortality were recorded at 12 months. Patients and surgery variables that were associated with increased mortality were used to develop a mortality model. Results: Mortality for the whole cohort was 19.4% at one year. From the variables tested only age >80 years, American Society of Anesthesiologists category, time to surgery (>48 hours), Charlson comorbidity index, sex, use of anti-coagulants, and body mass index <25 kg/m2 were associated with increased mortality and used to construct the mortality model. The area under the curve for the prediction model was 0.814. Functional outcome at one year was similar to preoperative status, even though their level of physical function dropped after the hip surgery and slowly recovered. Conclusion: The mortality prediction model that was developed in this study calculates the risk of death at one year for patients with hip fractures, is simple, and could detect high risk patients that need special management.

Keywords

References

  1. Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord. 2019;20:568. https://doi.org/10.1186/s12891-019-2950-0
  2. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49:1458-60. https://doi.org/10.1016/j.injury.2018.04.015
  3. Wiles MD, Moran CG, Sahota O, Moppett IK. Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur. Br J Anaesth. 2011;106:501-4. https://doi.org/10.1093/bja/aeq405
  4. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245-51. https://doi.org/10.1016/0895-4356(94)90129-5
  5. Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia. 2019;74:373-9. https://doi.org/10.1111/anae.14569
  6. Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018;19:369. https://doi.org/10.1186/s12891-018-2276-3
  7. Peterle VCU, Novaes MRCG, Junior PEB, et al. Osteoporotic hip fracture-comorbidities and factors associated with in-hospital mortality in the elderly: a nine-year cohort study in Brazil. PLoS One. 2022;17:e0272006. https://doi.org/10.1371/journal.pone.0272006 Erratum in: PLoS One. 2023;18:e0294101. https://doi.org/10.1371/journal.pone.0294101
  8. Ryan S, Politzer C, Fletcher A, Bolognesi M, Seyler T. Preoperative hypoalbuminemia predicts poor short-term outcomes for hip fracture surgery. Orthopedics. 2018;41:e789-96. https://doi.org/10.3928/01477447-20180912-03
  9. Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One. 2012;7:e46175. https://doi.org/10.1371/journal.pone.0046175
  10. Cher EWL, Allen JC, Howe TS, Koh JSB. Comorbidity as the dominant predictor of mortality after hip fracture surgeries. Osteoporos Int. 2019;30:2477-83. https://doi.org/10.1007/s00198-019-05139-8
  11. Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43:464-71. https://doi.org/10.1093/ageing/afu065
  12. Hall K. Overview of functional assessment scales in brain injury rehabilitation. NeuroRehabilitation. 1992;2:98-113. https://doi.org/10.3233/NRE-1992-2410
  13. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-83.
  14. Kontodimopoulos N, Pappa E, Niakas D, Tountas Y. Validity of SF-12 summary scores in a Greek general population. Health Qual Life Outcomes. 2007;5:55. https://doi.org/10.1186/1477-7525-5-55
  15. Danford NC, Logue TC, Boddapati V, Anderson MJJ, Anderson FL, Rosenwasser MP. Debate update: surgery after 48 hours of admission for geriatric hip fracture patients is associated with increase in mortality and complication rate: a study of 27,058 patients using the national trauma data bank. J Orthop Trauma. 2021;35:535-41. https://doi.org/10.1097/BOT.0000000000002075
  16. Rosso F, Dettoni F, Bonasia DE, et al. Prognostic factors for mortality after hip fracture: operation within 48 hours is mandatory. Injury. 2016;47 Suppl 4:S91-7. https://doi.org/10.1016/j.injury.2016.07.055
  17. Modig K, Erdefelt A, Mellner C, Cederholm T, Talback M, Hedstrom M. "Obesity Paradox" holds true for patients with hip fracture: a registry-based cohort study. J Bone Joint Surg Am. 2019;101:888-95. https://doi.org/10.2106/JBJS.18.01249
  18. Tahir M, Ahmed N, Samejo MQA, Jamali AR. The phenomenon of "obesity paradox" in neck of femur fractures. Pak J Med Sci. 2020;36:1079-83. https://doi.org/10.12669/pjms.36.5.1952
  19. Dowsey MM, Choong PFM, Paxton EW, Spelman T, Namba RS, Inacio MCS. Body mass index is associated with allcause mortality after THA and TKA. Clin Orthop Relat Res. 2018;476:1139-48. https://doi.org/10.1007/s11999.0000000000000108
  20. Evans JT, Mouchti S, Blom AW, et al. Obesity and revision surgery, mortality, and patient-reported outcomes after primary knee replacement surgery in the National Joint Registry: a UK cohort study. PLoS Med. 2021;18:e1003704. https://doi.org/10.1371/journal.pmed.1003704
  21. Ma L, Yu X, Weng X, Lin J, Qian W, Huang Y. Obesity paradox among patients undergoing total knee arthroplasty: a retrospective cohort study. BMC Surg. 2022;22:373. https://doi.org/10.1186/s12893-022-01806-6
  22. Sarabia-Cobo CM, Saenz-Jalon M, Velez-Carrera B, et al. Variables to predict mortality in hip fractures in patients over 65 years of age: a study on the role of anticoagulation as a risk factor. J Trauma Nurs. 2017;24:326-34. https://doi.org/10.1097/JTN.0000000000000313
  23. Arshi A, Lai WC, Iglesias BC, et al. Blood transfusion rates and predictors following geriatric hip fracture surgery. Hip Int. 2021;31:272-9. https://doi.org/10.1177/1120700019897878
  24. Okike K, Chan PH, Paxton EW. Effect of surgeon and hospital volume on morbidity and mortality after hip fracture. J Bone Joint Surg Am. 2017;99:1547-53. https://doi.org/10.2106/JBJS.16.01133
  25. Singh JA, Kwoh CK, Boudreau RM, Lee GC, Ibrahim SA. Hospital volume and surgical outcomes after elective hip/ knee arthroplasty: a risk-adjusted analysis of a large regional database. Arthritis Rheum. 2011;63:2531-9. https://doi.org/10.1002/art.30390
  26. Malik AT, Panni UY, Masri BA, Noordin S. The impact of surgeon volume and hospital volume on postoperative mortality and morbidity after hip fractures: a systematic review. Int J Surg. 2018;54(Pt B):316-27. https://doi.org/10.1016/j.ijsu.2017.10.072
  27. Thorne G, Hodgson L. Performance of the Nottingham Hip Fracture Score and Clinical Frailty Scale as predictors of short and long-term outcomes: a dual-centre 3-year observational study of hip fracture patients. J Bone Miner Metab. 2021;39:494-500. https://doi.org/10.1007/s00774-020-01187-x
  28. Bliemel C, Sielski R, Doering B, et al. Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture-development of a new scoring system. Osteoporos Int. 2016;27:1979-87. https://doi.org/10.1007/s00198-015-3472-8
  29. Cenzer IS, Tang V, Boscardin WJ, et al. One-year mortality after hip fracture: development and validation of a prognostic index. J Am Geriatr Soc. 2016;64:1863-8. https://doi.org/10.1111/jgs.14237
  30. Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol. 2003;56:788-95. https://doi.org/10.1016/s0895-4356(03)00129-x
  31. Jiang HX, Majumdar SR, Dick DA, et al. Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res. 2005;20:494-500. https://doi.org/10.1359/JBMR.041133
  32. Menendez-Colino R, Gutierrez Misis A, Alarcon T, et al. Development of a new comprehensive preoperative risk score for predicting 1-year mortality in patients with hip fracture: the HULP-HF score. Comparison with 3 other risk prediction models. Hip Int. 2021;31:804-11. https://doi.org/10.1177/1120700020947954
  33. Ekinci M, Bayram S, Gunen E, Col KA, Yildirim AM, Yilmaz M. C-reactive protein level, admission to intensive care unit, and high American Society of Anesthesiologists score affect early and late postoperative mortality in geriatric patients with hip fracture. Hip Pelvis. 2021;33:200-10. https://doi.org/10.5371/hp.2021.33.4.200
  34. van Baalen B, Odding E, van Woensel MP, Roebroeck ME. Reliability and sensitivity to change of measurement instruments used in a traumatic brain injur y population. Clin Rehabil. 2006;20:686-700. https://doi.org/10.1191/0269215506cre982oa
  35. Clement ND, MacDonald D, Simpson AH. The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22:1933-9. https://doi.org/10.1007/s00167-013-2776-5 Erratum in: Knee Surg Sports Traumatol Arthrosc. 2016;24:3696. https://doi.org/10.1007/s00167-015-3959-z
  36. Jacquet C, Pioger C, Khakha R, et al. Evaluation of the "Minimal Clinically Important Difference" (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2021;29:820-6. https://doi.org/10.1007/s00167-020-06026-0
  37. Diaz-Arribas MJ, Fernandez-Serrano M, Royuela A, et al. Minimal clinically important difference in quality of life for patients with low back pain. Spine (Phila Pa 1976). 2017;42:1908-16. https://doi.org/10.1097/BRS.0000000000002298
  38. Fong DYT, Wong JYH, Choi EPH, Lam KF, Kwok C. The English and Chinese language versions of the Short Form 12-item Health Survey are equivalent. Health Qual Life Outcomes. 2021;19:14. https://doi.org/10.1186/s12955-020-01653-0