Prognostic nomogram for risk of mortality after hip fracture surgery in geriatrics. Issue 4 (April 2022)

• Record Type: Journal Article
• Authors: Pan, Liping; Ning, Taiguo; Wu, Hao; Liu, Heng; Wang, Hongbin; Li, Xueying; Cao, Yongping
• Is Part Of: Injury. Volume 53:Issue 4(2022)
• Page Start: 1484
• Page End: 1489
• Publication Date: 2022-04
• Subjects: Hip fracture -- Geriatrics -- Mortality risk -- Nomogram -- Charlson comorbidity index; ASA American society of anesthesiologists -- AUC area under receiver operating characteristic -- CCI Charlson comorbidity index -- C-index concordance index -- DCA decision curve analysis -- E-PASS estimation of physiologic ability and surgical stress -- HR hazard ratio -- NA not applicable -- NHFS Nottingham hip fracture score -- NLR neutrophil-to-lymphocyte ratio -- O-POSSUM orthopedic physiologic and operative severity score for the enumeration of mortality and morbidity -- ROC receiver operating characteristic -- SCr serum creatinine; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.01.029
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Age, CCI, serum albumin, sodium, and hemoglobin are five identified risk variables for mortality after hip fracture surgery in geriatrics. The novel nomogram established with them for stratifying the mortality risk after hip fracture surgery in geriatrics had good accuracy and usefulness. External validation is warranted to confirm the performance of this nomogram. Abstract: Purpose: Hip fracture is a significant public health problem, with associated high morbidity and mortality. Orthopedic surgeons are concerned to improve prognosis and stratify mortality risk after hip fracture surgery. This study established a nomogram that combines the Charlson Comorbidity Index (CCI) with specific laboratory parameters to predict mortality risk after hip fracture surgery in geriatrics. Methods: The records of consecutive patients who underwent hip fracture surgery from January 2015 through May 2020 at one medical center were reviewed for perioperative factors and mortality. Patients with age ≥ 70 years who were diagnosed with intertrochanteric or femoral neck fractures were included. Patients who were diagnosed with pathological fracture, received only conservative treatment or lost to follow-up were excluded. A multivariate Cox proportional hazards regression model was used to identify risk factors. A nomogram was established with R software and evaluated using concordance (C)-index, area under receiver operating characteristic (AUC), calibration curves, and decision curve analysis (DCA). Results: In total, 454 patients were included with a mean age of 81.6 years. The mean follow-up and one-year mortality rate were 37.2 months and 10.4%, respectively. Five identified risk variables for mortality after hip fracture surgery in geriatrics comprised age (HR 1.05, 95% CI 1.01-1.08; P = 0.003), CCI (HR 1.38, 95% CI 1.24-1.54; P = 0.000), albumin (HR 1.78, 95% CI 1.31-2.43; P = 0.000), sodium (HR 1.59, 95% CI 1.18-2.15; P = 0.002) and hemoglobin (HR 1.46, 95% CI 1.07-2.00; P = 0.02). A nomogram was proposed and evaluated, showing a C-index of 0.76 ± 0.02. The AUCs for 6-month, 1-year, and 3-year mortality predictions were 0.83, 0.79, and 0.77, respectively. The calibration curve and DCA showed good discrimination and clinical usefulness. Conclusion: This novel nomogram for stratifying the mortality risk after hip fracture surgery in geriatrics incorporated age, CCI, serum albumin, sodium, and hemoglobin. Internal validation indicated that the model has good accuracy and usefulness. This nomogram had improved convenience and precision compared with other models. External validation is warranted to confirm its performance.