Predictive Value of Comprehensive Geriatric Assessment Scores for Mortality in Patients With Hip Fracture: A Retrospective Cohort Study

Abstract

To assess the predictive value of three scoring systems, namely the American Society of Anesthesiologists (ASA) classification, the Clinical Frailty Scale (CFS), and the Nottingham Hip Fracture Score (NHFS), in predicting mortality among patients with hip fractures. Materials and methodsThis retrospective cohort study included 628 participants aged 60 years and above who sought treatment at a UK hospital between January 2018 and December 2018. Data on age, gender, mortality, and assessment scores were collected. The area under the curve was calculated for each receiver operator characteristic (ROC). Cross-tabulation was performed to examine the association between various assessment scores and mortality using the chi-square test. ResultsThe mean age was 80.80±11.18 years. Females were 408 (64.97%). Higher CFS (p<0.001) and NHFS (p<0.001) scores were significantly associated with mortality, while the ASA score did not show a significant association (p=0.225). The calculated area under the curve (AUC) values were as follows: 0.71 (95% CI: 0.65 to 0.76) for CFS, 0.46 (95% CI: 0.39 to 0.53) for NHFS, and 0.41 (95% CI: 0.34 to 0.48) for the ASA score. Utilizing a cut-off of ≥6 for CFS, 57 individuals (98.3%) in the 30-day mortality group were correctly identified. Similarly, the ROC analysis determined a ≥5 cut-off for NHFS accurately predicting 50 patients (86.2%) who deceased within 30 days. Applying an ASA ≥3 cut-off resulted in a predictive mortality rate of 56 (96.6%). The NHFS score demonstrated the highest predictive capability for mortality, with patients scoring ≥5 having a significantly higher risk of mortality compared to those with a score <5. ConclusionThis study showed robust correlations between high CFS (≥6) and NHFS (≥5), and mortality within the hip fracture patient cohort.

Geriatric nutritional risk index predicts postoperative prognosis in older patients with hip fracture: A meta-analysis

“…Hip fractures are among the most common types of fractures in elderly people, with femoral neck fractures and intertrochanteric fractures being the most prevalent. [1] Except for patients who have severe complications and who are not surgical candidates, conservative treatment can be considered for elderly patients who are not tolerant of surgery. If the patient overall health permits, surgical treatment of elderly hip fracture patients should be performed as early as possible within the short-term period following the injury.…”

“…[2,3] Despite the continuous improvements in medical standards, surgical techniques, and nursing care, the 1-year postoperative mortality rate for elderly hip fracture patients has reached 20% to 40%. [1,4–6] Therefore, timely and accurate identification of the risk factors for adverse outcomes in elderly hip fracture patients undergoing surgery is crucial to improve quality of life and reduce mortality.…”