Predicting 30-Day and 180-Day Mortality in Elderly Proximal Hip Fracture Patients: Evaluation of 4 Risk Prediction Scores at a Level I Trauma Center

Abstract

This study evaluated the use of risk prediction models in estimating short- and mid-term mortality following proximal hip fracture in an elderly Austrian population. Data from 1101 patients who sustained a proximal hip fracture were retrospectively analyzed and applied to four models of interest: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), Charlson Comorbidity Index, Portsmouth-POSSUM and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) Risk Score. The performance of these models according to the risk prediction of short- and mid-term mortality was assessed with a receiver operating characteristic curve (ROC). The median age of participants was 83 years, and 69% were women. Six point one percent of patients were deceased by 30 days and 15.2% by 180 days postoperatively. There was no significant difference between the models; the ACS-NSQIP had the largest area under the receiver operating characteristic curve for within 30-day and 180-day mortality. Age, male gender, and hemoglobin (Hb) levels at admission <12.0 g/dL were identified as significant risk factors associated with a shorter time to death at 30 and 180 days postoperative (p < 0.001). Among the four scores, the ACS-NSQIP score could be best-suited clinically and showed the highest discriminative performance, although it was not specifically designed for the hip fracture population.

Emergency department prediction model for 30-day mortality after hip fracture: the Spanish National Hip Fracture Registry (RNFC) cohort

“…30-day mortality in our cohort was 7.7% (2321 patients) and was comparable to other studies. Nia et al 8 report a 30-day mortality of 6.1% in their cohort of 1101 hip fractures, Van Rijckevorsel et al 16 7.9% in 2458, Karres et al 5 8.2% in 1050, Haugan et al 17 7.5% in 3651, Maxwell et al 6 7.8 in 4967, and in 2020, the Royal College of Physicians National Hip Fracture Database reported a 6.5% mortality in 67,302 patients. 18 Only 2 predictive models of 30-day mortality have been specifically developed for hip fracture patients.…”

“…However, no analysis of its predictive performance is reported, nor has it been validated in consequent studies. 8 RNFC model include 4 variables (age, gender, ASA score, pre-fracture mobility) that are also use in this model. The other 3 variables (dementia, pathological fracture, and osteoprotective medication) are not included in this model.…”

“…Up to know, NFSH has showed the best predicted-to-observed ratio, and it is a model with extensive validation. [5][6][7][8] The ideal predictive model must be precise, easy, and quick to apply, and based on information available before surgery. The early estimation of the prognosis of hip fracture could modify preoperative care, time of surgery or type of treatment.…”

“…Up to know, NFSH has showed the best predicted-to-observed ratio, and it is a model with extensive validation. 5–8…”

Development and validation of a novel nomogram of 1-year mortality in the elderly with hip fracture: a study of the MIMIC-III database

“…They found that the NHFS was the most promising models with reasonable discrimination and extensive validation for predicting 30-day mortality in hip fracture surgery. Nia et al 54 compared four risk prediction scores for 30-day and 180-day mortality in elderly proximal hip fracture patients, including the POSSUM, the Portsmouth-POSSUM (P-POSSUM), the CCI and National Surgical Quality Improvement Programme (NSQIP) Risk Score. They found that ACS-NSQIP had the highest predictive value for both 30-day and 180-day mortality in elderly proximal hip fracture patients.…”