A New Nomogram Model for Predicting 1-Year All-Cause Mortality After Hip Arthroplasty in Nonagenarians With Hip Fractures: A 20-Year Period Retrospective Cohort Study

Abstract

BackgroundChina has become an ageing society and as it continues to age, it will face an increasing number of hip fractures in nonagenarians. However, few preoperative assessment tools to determine the postoperative mortality risk in nonagenarians with hip fracture were available. The aim of this study was to identify all-cause mortality risk factors after hip arthroplasty in nonagenarians with hip fractures and to establish a new nomogram model to optimize the individualized hip arthroplasty in nonagenarians with hip fractures.MethodsWe retrospectively studied 246 consecutive nonagenarians diagnosed with hip fracture from August 2002 to February 2021 at our center. During the follow-up, 203 nonagenarians with a median age of 91.9 years treated with hip arthroplasty were included, of which 136 were females and 67 were males, and 43 nonagenarians were excluded (40 underwent internal fixation and 3 were lost to follow-up). The full cohort was randomly divided into training (50%) and validation (50%) sets. The potential predictive factors for 1-year all-cause mortality after hip arthroplasty were assessed by univariate and multivariate COX proportional hazards regression on the training set, and then, a new nomogram model was established and evaluated by concordance index (C-index) and calibration curves.ResultsAfter analyzing 44 perioperative variables including demographic characteristics, vital signs, surgical data, laboratory tests, we identified that age-adjusted Charlson Comorbidity Index (aCCI) (p = 0.042), American Society of Anesthesiologists (ASA) classification (p = 0.007), Urea (p = 0.028), serum Ca2+ (p = 0.011), postoperative hemoglobin (p = 0.024) were significant predictors for 1-year all-cause mortality after hip arthroplasty in the training set. The nomogram showed a robust discrimination, with a C-index of 0.71 (95%CIs, 0.68–0.78). The calibration curves for 1-year all-cause mortality showed optimal agreement between the probability as predicted by the nomogram and the actual probability in training and validation sets.ConclusionA novel nomogram model integrating 5 independent predictive variables were established and validated. It can effectively predict 1-year all-cause mortality after hip arthroplasty in nonagenarians with hip fracture and lead to a more optimized and rational therapeutic choice.

Complication Rates and Survival of Nonagenarians after Hip Hemiarthroplasty versus Proximal Femoral Nail Antirotation for Intertrochanteric Fractures: A 15‐Year Retrospective Cohort Study of 113 Cases

“…In general, arthroplasty is associated with a relatively greater severity of surgical trauma and increased blood loss, even when performed by proficient surgeons, compared to PFNA. Anemia caused by blood loss and bleeding is associated with postoperative mortality and morbidity in the elderly 7,44 . Preventing or timely correcting anemia is vital for this patient population.…”

“…Anemia caused by blood loss and bleeding is associated with postoperative mortality and morbidity in the elderly. 7 , 44 Preventing or timely correcting anemia is vital for this patient population. In the present study, the blood loss, blood transfusion, and transfusion rates during the surgical procedure in the bipolar HA group were significantly higher than those in the PFNA group.…”

“…However, the two fracture types are not only epidemiologically different but also impact differently on the elderly. Intertrochanteric fractures are slightly more prevalent compared to femoral neck fractures, 5–7 and are typically more characteristically osteoporotic 8 . Patients with intertrochanteric fractures tend to be older and more debilitated, often accompanied by higher mortality and disability rates 8–10 .…”

The Nomogram Model and Factors for the Postoperative Mortality of Elderly Patients with Femoral Neck Fracture Undergoing Artificial Hip Arthroplasty: A Single‐Institution 6‐Year Experience

“…Further, the stress of surgical trauma can cause heart failure, arrhythmia, and respiratory dysfunction, endangering the life of patients. 49 Nomogram, as a prognosis statistic model, makes prediction easier and more convenient 50,51 and has higher accuracy and convenience than other models. 52 We included the risk factors found by logistic analysis into the nomogram model, which was successfully validated using the ROC curve and Hosmer-Lemeshow test.…”

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study

“…Surgeons and patients are often hesitant to proceed with surgery due to concerns over advanced age and pre-existing comorbidities that may lead to postoperative complications and mortality 9 , 10 . While certain experts 11 , 12 particularly regarding the survival results, have indicated advantages, there is concern 13 – 17 among certain research that high proportion of complication rates after surgery were observed whether they had been treated surgically or conservatively. Due to multiple comorbidities, leaving hip fractures untreated can result in 1-year mortality rates of over 60% for nonagenarians and centenarians, as well as other adverse outcomes including longer length of hospital stay (LOS), frequent readmissions, and increased rates of mortality and complications 18 , 19 .…”