The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS90)

Abstract

Summary The AHFS 90 was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS 90 has a good accuracy and in most risk categories a good calibration. In our study population, the AHFS 90 yielded a maximum prediction of early mortality of 64.5%. Purpose Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS 90 ). Methods Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS 90 , which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks. Results One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS 90 includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS 90 had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS 90 overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS 90 had a maximal prediction of early mortality of 64.5% in this study population. Conclusion The AHFS 90 accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS 90 yielded a maximum prediction of early mortality of 64.5%. Supplementary information The online version contains supplementary material available at 10.1007/s00198-023-06696-9.

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

“…In addition, Thinggaard et al 40 demonstrated that, despite being in high-income nations, individuals who are 90 years old or older have considerably shorter life expectancy compared to those who are 80 years old. Our investigation of nonagenarians and centenarians revealed lower mortality rates at 1-month, 1-year, and 2-year intervals after surgery compared to previous studies which has been reported as 5.6–11.1% for one month mortality 41 , 42 , and 1-year to 2-year mortality ranging from 23.4–40.6% 27 , with respective rates of 2.0, 15.0, and 28.0%. After matching, surgical and nonsurgical groups of patients were estimated to survive 50.4 and 13.2 months in median, and 5-year survival rates were estimated as 42% (33%, 52%) and 26% (14%, 50%) respectively, which is lower than the others 39 .…”

Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery?

“…To place the expert-driven estimates into perspective, a comparison was made with data-driven prediction models. An overview of the maximum predicted risks and the respective predictor variables of the Nottingham Hip Fracture Score (NHFS) [ 22 ], Almelo Hip Fracture Score (AHFS) [ 20 ], AHFS 90 [ 78 ] and Brabant Hip Fracture Score (BHFS) [ 21 ] is shown in Table 5 . This overview shows that most predictors also appear in the vignettes.…”

Development and validation of a prognostic nomogram for 3-year all-cause mortality risk among elderly patients undergoing surgery for osteoporotic fractures

“…Therefore, high-risk patient detection is critical to the provision of individualized care that may potentially enhance patient prognosis while minimizing physical and economic burdens of OPF patients. Prognostic models that incorporate multiple risk factors, such as, patient age, sex, comorbidities, and bone mineral density, were previously shown to assist clinicians in recognizing high-risk patients (10)(11)(12)(13)(14)(15). Using these models, clinicals can accurately estimate postoperative patient mortality risk, and notify patients and their caregivers of the potential outcomes of surgery.…”