Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery

Abstract

Background and Objectives: The aim of this study was to evaluate the prognosis after treatment for femoral neck fracture, to assess the impact of delay to surgery, and to devise a clinical prediction rule and score. Methods: A prospective observational study was conducted in which 1780 patients treated surgically in two teaching hospitals between 1 November 1997 and 31 October 1999 were followed over 12 months. Logistic regression was used to distinguish the effects of predictor variables on survival. Using a probit transformation of the predicted posterior probabilities of death, a prognostic score was devised with scores constrained so that a nominal score of approximately 90 represented a 50:50 chance of survival over 12 months. Results: Mortality was 30.1% in men and 19.5% in women. Increasing age, male gender, longer pre-operative delay, a higher American Society of Anesthesiology score, a lower Mental Test score, and a lower activities of daily living (Barthel) score were associated with increased risks of death. Of those waiting between 1 and 5 days for surgery, approximately 8 medium-risk and 17 high-risk patients (with prognostic scores of 90 and 120, respectively) would have to have their delay reduced to Ͻ24 hours to yield one additional survivor. Conclusion: The application of prediction rules must be guided by ethical, social, and scientific concerns.

Predictors of Prognosis for Elderly Patients with Poststroke Hemiplegia Experiencing Hip Fractures

“…Therefore, male gender, three or more comorbidities, Category III or IV ASA rating, and weaker prefracture ambulatory status predicted mortality. Similar results have been reported for patients without hemiplegia who have hip fractures [5,9,10,13,40]. In our preliminary analysis, age, type of fracture, prefracture ambulatory status, and side of fracture did not have an effect on recovery of prefracture ambulatory status.…”

“…Various factors (eg, age [9,38], gender [10,13,38], ASA rating [9,17], dementia [4], and type of fracture [28,29]) reportedly affect ambulatory status and mortality of elderly patients with hip fractures, but little is known of any differences in general characteristics between patients with and without hemiplegia who had hip fractures, factors predicting recovery of prefracture ambulatory status, and mortality of patients with hemiplegia after stroke who experienced hip fractures.…”

Mortality After Distal Femur Fractures in Elderly Patients

“…Surgical delay after hip fractures has been studied extensively but continues to be a source of debate. Gdalevich et al [22] and Elliott et al [19] found surgical delay reduced the probability of 1-year survival. However, an effect of preexisting disease severity on mortality also was found.…”

Alterstraumatologie – neue Wege, neue Chancen

“…Die 1-JahresMortalität nach einer Hüftfraktur liegt nach wie vor bei bis zu 30% [5]. Lediglich 50% der betroffenen Patienten erreichen wiederum ihren funktionellen Zustand vor dem Trauma [6].…”