The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Abstract Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.

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Comparison of Sarcopenia with Modified Frailty Index as a Predictor of Adverse Outcomes in Critically Ill Elderly Patients

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i32b31763 ◽

2021 ◽

pp. 200-206

Author(s):

Shrirang Bhurchandi ◽

Sachin Agrawal ◽

Sunil Kumar ◽

Sourya Acharya

Keyword(s):

Elderly Patients ◽

Critically Ill ◽

Health Care Cost ◽

Frailty Index ◽

The Elderly ◽

Time Frame ◽

Adverse Outcomes ◽

Cross Sectional ◽

Parametric Data ◽

Modified Frailty Index

Background: Ageing is a global fact affecting both developed and developing countries.It brings out various catabolic changes in body resulting in frailty(i.e. the person is not able to with stand minor stresses of the environment, due to reduced reserves in psychologicalreserve of several organ system).Thus causing a great burden of disease, dependence & health care cost. Sarcopenia is the leading component for frailty in the elderly population, but very few studies have been done in India for correlating frailty with sarcopenia. Aim: To compare sarcopenia with modified frailty index (MFI) as a predictor of adverse outcomes in critically ill elderly patients. Methodology: Cross-sectional study will be performed on all the critically ill geriatric subjects/patients coming to all the ICU's of AVBRH, Sawangi (M), Wardha who will satisfy various inclusion and exclusion criteria for selection and all standard parametric & non-parametric data will be assessed by using standard descriptive & inferential statistics. Expected Results: In our study, we are anticipating that the Modified frailty index to be a better predictor of adverse outcomes in terms of mortality as compared to sarcopenia in the critically ill elderly patients. Also, we are anticipating that sarcopenia to be the most important contributor of frailty in critically ill elderly patients and the prevalence of frailty will be high in critically ill elderly patients. Limitation: Due to limited time frame & resources we will not be able to follow up the patients.

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A New Risk Score to Predict In-Hospital Mortality in Elderly Patients With Acute Heart Failure: On Behalf of the Journey HF-TR Study Investigators

Angiology ◽

10.1177/0003319720941758 ◽

2020 ◽

Vol 71 (10) ◽

pp. 948-954

Author(s):

Gülay Gök ◽

Mehmet Karadağ ◽

Ümit Yaşar Sinan ◽

Mehdi Zoghi

Keyword(s):

Heart Failure ◽

Elderly Patients ◽

Hospital Mortality ◽

Risk Score ◽

Validation Cohort ◽

Characteristic Curve ◽

Univariate Analysis ◽

Previous History ◽

Turkish Population ◽

Patient Journey

We aimed to predict in-hospital mortality of elderly patients with heart failure (HF) by using a risk score model which could be easily applied in routine clinical practice without using an electronic calculator. The study population (n = 1034) recruited from the Journey HF-TR (Patient Journey in Hospital with Heart Failure in Turkish Population) study was divided into a derivation and a validation cohort. The parameters related to in-hospital mortality were first analyzed by univariate analysis, then the variables found to be significant in that analysis were entered into a stepwise multivariate logistic regression (LR) analysis. Patients were classified as low, intermediate, and high risk. A risk score obtained by taking into account the regression coefficients of the significant variables as a result of the LR analysis was tested in the validation cohort using receiver operating characteristic curve analysis. In total, 6 independent variables (age, blood urea nitrogen, previous history of hemodialysis/hemofiltration, inotropic agent use, and length of intensive care stay) associated with in-hospital mortality were included in the analysis. The risk score had a good discrimination in both the derivation and validation cohorts. A new validated risk score to determine the risk of in-hospital mortality of elderly hospitalized patients with HF was developed by including 6 independent predictors.

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The Risk Prediction Model for Healthcare-Associated Infections among Elderly Patients Underwent Pancreaticoduodenectomy

10.21203/rs.3.rs-138219/v1 ◽

2021 ◽

Author(s):

Yuejing Feng ◽

Hongwu Yao ◽

Jie Li ◽

Mingmei Du ◽

Xibao Gao ◽

...

Keyword(s):

Elderly Patients ◽

Prediction Model ◽

Sensitivity And Specificity ◽

Prediction Accuracy ◽

Urinary Catheter ◽

Characteristic Curve ◽

Univariate Analysis ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Significant Factors

Abstract Background: The elderly are a high-risk group of healthcare-associated infections (HAIs) after pancreaticoduodenectomy (PD), and the effective prediction model may be beneficial to HAIs control. Methods: The data were obtained from Hospital Infection Surveillance System. The BP-ANN model was conducted according to univariate analysis. The receiver operating characteristic curve (ROC), the prediction accuracy, sensitivity and specificity were used to estimate the predicted performance. The final weight coefficients were calculated to illustrate the relative importance of indicators. Results: Of 688 elderly patients underwent PD, 83 (12.06%) were diagnosed with HAIs. 9 significant factors (P<0.05) including weight, fever, continuous fever for more than three days, blood routine abnormal percentage, ever livered in intensive care unit (ICU), antibacterial combination, postoperative antibacterial use days, ventilator use and urinary catheter use days were included into prediction model. The prediction accuracy in testing sets was 93.79%, and the sensitivity and specificity were 0.67 and 0.97. The contribution level of 9 significant factors were 10.65%, 8.54%, 10.17%, 9.64%, 9.26%, 10.02%, 12.53%, 11.90% and 17.29%, respectively. Conclusions: The 9-9-1 BP-ANN prediction model underpinned by complex factors in this study has relatively excellent performance for HAIs prediction among elderly patients after PD. Urinary catheter use days, postoperative antibacterial use days, ventilator use, weight and continuous fever for more than three days are the top five contribution indicators for HAIs prediction, which should be fully taken into consideration when developing HAIs prediction for the PD patients.

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315 Cardiac surgery in the elderly: the underestimate role of frailty in the decision making

European Heart Journal Supplements ◽

10.1093/eurheartj/suab147.004 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Pasquale Campana ◽

Maddalena Conte ◽

Maria Emiliana Palaia ◽

Laura Petraglia ◽

Adele Ferro ◽

...

Keyword(s):

Decision Making ◽

Cardiac Surgery ◽

Nutritional Status ◽

Elderly Patients ◽

Frailty Index ◽

The Elderly ◽

Risk Scores ◽

Surgical Risk ◽

The Impact

Abstract Aims Elders represent the most common population with indication to cardiac surgery, also presenting the highest mortality/disability after interventions. Both for valve and coronary artery surgery the estimation of the surgical risk, including the frailty assessment, is recommended to guide the decision making. However, frailty results not exhaustively assessed by the commonly used surgical risk scores such as EuroSCORE I-II and score of the Society of Thoracic Surgeons and is mostly used the Kat’s Index (included in the latest European guidelines). This study aims at establishing the feasibility and the value of a Comprehensive Geriatric Assessment (CGA) in elderly undergoing cardiac surgery. Methods From June 2021we consecutively enrolled 50 elderly patients undergoing cardiac surgery (age > 65 years old). All patients underwent CGA with an expert geriatrician and the demographic, biometrics, clinical and echocardiographic data were collected. We evaluated frailty and disability (Kats index, Barthel Index and Frailty Index FI), cognitive status (Montreal Cognitive Assessment MOCA, Mini Mental State Examination MMSE and Geriatric Depression Scale), physical status (Tinetti test, Short Performance Physical Battery SPPB, Physical Activity Scale for the Elderly PASE and 6-min Walking test), delirium condition, sarcopenia and nutritional status (Mini-Nutritional Assessment MNA). A clinical, echocardiographic, and geriatric 3-month follow-up is planned. In particular, we are evaluating the impact of frailty, assessed by CGA, on peri-surgical outcome and the potential additive value of a CGA on the commonly used surgical risk-scores and Kat’s Index. Furthermore, we are assessing the impact of cardiac surgery of frail elderly at GCA. Results The CGA was feasible in all patients and lasted 1 h/patient. In our baseline data, only 23% of the enrolled patients resulted ‘frail’ according to Kat’s Index. However, in the remaining 77% of the study population, the CGA have identified 30% of patients with increased frailty index and 30% with disability, assessed by Barthel Index and physical function indexes (PASE and SPPB). In these patient, frailty and disability were associated to impaired nutritional status, assessed at MNA. Furthermore, 40% of the patients of this group resulted sarcopenic at the hand grip test. The cognitive valuation has shown a cognitive impairment in the 20% of patients at the MMSE and the 70 % at the MOCA. Of note, the 40% of the patients resulted to suffer of depression, not diagnosed before the GCA. At mid-November 2021 the follow-up will be completed. Conclusions The preliminary results of the presents study suggest that in patients undergoing cardiac surgery frailty is currently underdiagnosed. The follow-up analysis will establish if a CGA has an additive value on common surgical risk estimators. This study has a potential impact on the risk stratification of elderly patients undergoing invasive procedures and defines the need of a geriatrician in the heart team.

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Colorectal Cancer in Octogenarian and Nonagenarian Patients: Clinicopathological Features and Survivals

Annals of Coloproctology ◽

10.3393/ac.2020.01.19.2 ◽

2020 ◽

Vol 36 (5) ◽

pp. 323-329 ◽

Cited By ~ 1

Author(s):

Soo Min Lee ◽

Jun Sang Shin

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Univariate Analysis ◽

Survival Rates ◽

The Elderly ◽

Clinicopathological Parameters ◽

Female Ratio ◽

Significant Difference ◽

Differentiation Stage ◽

Male To Female

Purpose: Elderly population will comprise a substantial proportion of colorectal cancer (CRC) patients. We examined patients older than 80 years according to their clinical and pathological characteristics to fully understand the elderly patients.Methods: CRC patients, 60 years or older at diagnosis, admitted between 2009 and 2014 at our hospital were enrolled. The patients were divided into 2 groups: elderly (aged > 80 years, n = 133), and controls (aged 60 to 79 years, n = 596). Patient’s demographics, risk factors for prognosis of CRC, Clinicopathological parameters, treatment, and survival rates were compared.Results: The mean ages were 83.9 and 64.8 years, respectively. Male-to-female ratio and tumor sidedness were comparable in both groups. Prognostic factors found in univariate analysis; differentiation, stage, lymphovascular invasion, and carcinoembryonic antigen showed no statistical difference. The microsatellite instability status and number of retrieved lymph nodes were also similar (17.2 vs 21.6, P = 0.505). A significant difference was found in the treatment approach for chemotherapy as the elderly patients with stage III and IV tend to have omitted adjuvant (43.6% vs. 92.8%, P < 0.001) or palliative (35.8% vs. 89.4%, P = 0.016) chemotherapy. Except in stage I, elderly patients showed significantly lower overall survival rates.Conclusion: Current study shows far-elderly patients with CRC were less likely to receive standard treatments, which might have resulted in an inferior outcome. As the number of elderly patients with CRC increase, our results provide a basis for further clinical and molecular investigations of elderly CRC patients.

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Management and Survival of Elderly and Very Elderly Patients with Ovarian Cancer: An Age-Stratified Study of 1123 Women from the FRANCOGYN Group

Journal of Clinical Medicine ◽

10.3390/jcm9051451 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1451

Author(s):

Yolaine Joueidi ◽

Ludivine Dion ◽

Sofiane Bendifallah ◽

Camille Mimoun ◽

Alexandre Bricou ◽

...

Keyword(s):

Ovarian Cancer ◽

Elderly Patients ◽

Elderly Women ◽

Residual Disease ◽

Univariate Analysis ◽

Advanced Ovarian Cancer ◽

The Elderly ◽

Figo Stage ◽

Very Elderly ◽

Cancer Management

Elderly women with ovarian cancer are often undertreated due to a perception of frailty. We aimed to evaluate the management of young, elderly and very elderly patients and its impact on survival in a retrospective multicenter study of women with ovarian cancer between 2007 to 2015. We included 979 women: 615 women (62.8%) <65 years, 225 (22.6%) 65–74 years, and 139 (14.2%) ≥75 years. Women in the 65–74 years age group were more likely to have serous ovarian cancer (p = 0.048). Patients >65 years had more >IIa FIGO stage: 76% for <65 years, 84% for 65–74 years and 80% for ≥75 years (p = 0.033). Women ≥75 years had less standard procedures (40% (34/84) vs. 59% (104/177) for 65–74 years and 72% (384/530) for <65 years (p < 0.001). Only 9% (13/139) of women ≥75 years had an Aletti score >8 compared with 16% and 22% for the other groups (p < 0.001). More residual disease was found in the two older groups (30%, respectively) than the younger group (20%) (p < 0.05). Women ≥75 years had fewer neoadjuvant/adjuvant cycles than the young and elderly women: 23% ≥75 years received <6 cycles vs. 10% (p = 0.003). Univariate analysis for 3-year Overall Survival showed that age >65 years, FIGO III (HR = 3.702, 95%CI: 2.30–5.95) and IV (HR = 6.318, 95%CI: 3.70–10.77) (p < 0.001), residual disease (HR = 3.226, 95%CI: 2.51–4.15; p < 0.001) and lymph node metastasis (HR = 2.81, 95%CI: 1.91–4.12; p < 0.001) were associated with lower OS. Women >65 years are more likely to have incomplete surgery and more residual disease despite more advanced ovarian cancer. These elements are prognostic factors for women’s survival regardless of age. Specific trials in the elderly would produce evidence-based medicine and guidelines for ovarian cancer management in this population.

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Risk factors for hospitalization in elderly cancer patients receiving chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.9035 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 9035-9035

Author(s):

J. M. Kleiner ◽

E. Culakova ◽

D. C. Dale ◽

J. Crawford ◽

M. S. Poniewierski ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Cancer Patients ◽

Solid Tumors ◽

Univariate Analysis ◽

The Elderly ◽

Hematologic Toxicity ◽

Elderly Age ◽

Elderly Cancer Patients ◽

Increased Risk

9035 Background: Chemotherapy-associated hospitalization is a major source of morbidity and cost in cancer care, particularly for elderly (age ≥ 65) cancer patients. Hospitalization in the elderly often leads to an irreversible decline in functional status unrelated to the acute event that prompted hospital admission. Currently, little is known about the risk factors that may lead to increased risk of hospitalization in elderly patients receiving chemotherapy (CTX). Methods: 871 patients with solid tumors or lymphoma initiating a new CTX regimen were prospectively enrolled at 60 randomly selected US community oncology sites between 8/2004 and 10/2005. Of these, 361 elderly patients aged 65–91 were identified and followed. Primary endpoint of this investigation was hematologic toxicity and hospitalization was secondary. Pre- CTX patient data were analyzed for increased risk of hospitalization in univariate analysis using the chi-square test. Results: A total of 155 (18%) patients were hospitalized resulting in 215 hospitalizations. Median time to first hospitalization was the second cycle of CTX. 81/361 (22%) of elderly patients were hospitalized compared to only 74/510 (15%) of younger patients (p=0.003). The rate of hospitalization increased in a linear fashion between ages 65–80. Reasons for hospitalization in the elderly included infection, fever, or febrile neutropenia (36%), cardiopulmonary disease (CPD) (12%), vomiting or dehydration (13%), other gastrointestinal (11%), transfusion (8%), thrombosis (4%), CTX administration (4%), and other (13%). Major independent pre-CTX factors that predicted hospitalization in the elderly included male gender (p=0.0004), hemoglobin <11 g/dL (p=0.02), abnormal platelet count (<150k or >350k) (p=0.05), CPD (p=0.03), creatinine >1.5 mg/dL (p=0.05), and ≥ 2 concomitant medications (p=0.0008). Elderly patients with lung cancer (p=0.001) and lymphoma (p=0.05) had significantly higher rates of hospitalization when compared to other solid tumors. Conclusions: These data suggest that the risk of hospitalization increases in elderly cancer patients with age and that pre-CTX factors may be useful in identifying a subpopulation at increased risk for hospitalization. No significant financial relationships to disclose.

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Initial Characteristics, Treatment and Prognosis Of Elderly (≥ 70 years) Patients With Chronic Lymphocytic Leukemia (CLL): An Analysis Of a Series Of 367 Cases

Blood ◽

10.1182/blood.v122.21.4155.4155 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4155-4155

Author(s):

Tycho Baumann ◽

Julio Delgado ◽

Rodrigo Santacruz ◽

Alejandra Martínez-Trillos ◽

Cristina Royo ◽

...

Keyword(s):

Elderly Patients ◽

Prognostic Value ◽

Clinical Stage ◽

Univariate Analysis ◽

The Elderly ◽

Response To Therapy ◽

Advanced Clinical Stage ◽

Younger Patients ◽

Mutational Status ◽

Co Morbidity

Abstract Introduction Although CLL predominates in the elderly, there are few studies focusing on the characteristics, treatment, and prognosis of elderly patients with CLL. Patients and Methods Retrospective single center study of 949 patients diagnosed with CLL between 1990 and 2012. We defined two age-groups:<70 years (“young”, n=582) and ≥ 70 (“elderly”, n=367). Statistical analysis was performed with SPSS and R. Results Baseline characteristics of patients are shown in the Table. Median follow-up time was 7.8 years (0.1-23.1) for the overall series. Elderly patients presented with more advanced clinical stage (p<.001) and higher B2M (p<.001) than younger ones. However, elderly patients presented with a lower WBC count (19.6 vs. 23.6 x 109/L; p<.001) and a longer LDT (p=.004). In contrast to younger patients, both sexes were equally distributed within the elderly (p<.001). There were no significant differences regarding ZAP70, FISH cytogenetics, IGHV mutational status and mutations of NOTCH1 and SF3B1. Elderly patients were treated less frequently (39% vs. 62%; p<.001; TTFT 23.8% vs. 41.9% at 3 years; p<.001) and the type of treatment given to elderly vs. younger patients was: alkylating agents (70% vs. 36%), purine analogs (10% vs. 32%), chemoimmunotherapy (5% vs. 25%), other (15% vs. 7%) (p<.001). The response rate was lower in elderly patients (49 % with 14% CR vs. 69% with 31% CR; p<.001). The overall survival (OS) was shorter in the elderly (6.6 vs. 13.3 years; p<.001) in whom a higher CLL-unrelated mortality (34.9% vs. 6.9% at 10 years; p<.001) was observed. The univariate analysis showed a correlation between advanced clinical stage (p<.001), increased B2M (p<.001), 11q- and 17p- (p=.016), high ZAP70 (p<.001), unmutated IGHV (p=.002) and NOTCH1 (p=.002) and SF3B1 mutations (p<.001) and shorter OS. A high co-morbidity index at diagnosis (CIRS-D >6) also correlated with OS (p=.064). With the only exception of cytogenetics by FISH all variables included in the multivariate analysis retained independent prognostic value (clinical stage: HR 1.68, p=.012; ZAP-70: HR 1.64, p=.01; CIRS-D: HR 1.42, p=.035 and B2M: HR 1.09, p=.021). IGHV mutational status, NOTCH1 and SF3B1 mutations were not included in the analysis due to missing data. In elderly patients requiring treatment only co-morbidity burden at treatment initiation (CIRS-T>4: HR 2.13, p=.009) and response to therapy (PR vs. CR: HR 2.03, p=.039; and failure vs. CR: HR 4.33, p<.001) had independent prognostic value for OS. Conclusions Patients above 70 years were diagnosed at more advanced phases of the disease than younger ones but no significant differences in the biology of the disease were observed. Importantly, once patients required treatment only co-morbidity and response to therapy were prognostically relevant. Unfortunately, however, only a small proportion of elderly patients could receive effective therapy as currently conceived. In addition, an important fraction of patients died because of causes not related to CLL. These findings underscore the importance of developing active and well tolerated treatments, as well as that of a comprehensive medical care for elderly patients with CLL. Disclosures: No relevant conflicts of interest to declare.

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Thirty-Day Mortality and Survival in Elderly Patients Undergoing Neurosurgery

Neurosurgery ◽

10.1093/neuros/nyz001.3 ◽

2019 ◽

Vol 84 (5) ◽

pp. E270-E271

Author(s):

Emily Rose Bligh ◽

Yahia Al-Tamimi ◽

Priyank Sinha ◽

Daisy Smith

Keyword(s):

Logistic Regression ◽

Elderly Patients ◽

Current Model ◽

Frailty Index ◽

The Elderly ◽

Ageing Population ◽

Predictors Of Mortality ◽

Significant Difference ◽

Group A ◽

Group B

Abstract INTRODUCTION With an ageing population and advances in neuroanaesthesia and critical care, there is an increasing subgroup of patients greater than 70 yr of age presenting to neurosurgical departments and undergoing surgery. We are now moving towards the idea of a frailty index. The aim of the current study is to investigate 30-d mortality and survival in this cohort following emergency and elective neurosurgery. METHODS Retrospective cohort study. All patients aged 70 yr and above, who had undergone a neurosurgical procedure from April 2015 to April 2017 were identified. Online patient electronic records were retrieved to gather information related to procedure type, co-morbidities, days in hospital, discharge destination, complications and mortality. Logistic regression analysis was used to identify predictors of mortality. RESULTS A total of 798 patients in total of whom 623 were <80 yr (group A) and 175 were >80 yr (group B). Male : Female = 3 : 1. Mean age of the study was 76 yr. There were 390 elective and 408 emergency admissions. Overall 30-d mortality = 5.6% (8% in group B). Overall survival was 86.5% in group A and 79.4% in group B. There was a significant difference in 30-d mortality between elective (0.8%) and emergency (10.3%) patients. About 84.5% of patients were discharged back to their usual place of residence in group A but this figure was 68.9% for group B. Logistic regression found emergency surgery (P > .001) and degenerative spine diagnosis to be independent predictors of mortality (P = .05). CONCLUSION The current model for accepting elderly patients is associated with a good overall outcome. The elderly should not be refused neurosurgery on their age per se. We have applied fairly strict and stringent criteria particularly in SAH and TBI.

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Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgery

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01962-6 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Lili Yu ◽

Yanbin Zhu ◽

Wei Chen ◽

Hui Bu ◽

Yingze Zhang

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

The Elderly ◽

Individual Risk ◽

Factors Associated ◽

Postoperative Stroke

Abstract Objectives Stroke is one of the rare but devastating complications after hip fracture in the elderly. By far, there is still scarce data on postoperative stroke in elderly patients with hip fractures. Methods This was a retrospective study of prospectively collected data. Between October 2014 to December 2018, patients aged above 65 years who underwent operative treatment for hip fractures were included. Inpatient medical surveillance and scheduled telephone follow-up at 1, 3, 6, and 12 months after operation was conducted to identify who developed an incident stroke. Variables of interests were extracted from patients’ inpatient medical records. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors associated with stroke. Results During the study period, a total of 3743 patients were included, among whom 56 were found to have a stroke after operation, representing an incidence of 1.5% (95% CI, 1.1 to 1.9%). The multivariate analyses showed that advanced age (1-year increment; OR, 1.32; 95% CI, 1.08 to 1.48), history of previous stroke (OR, 4.79; 95% CI, 1.86 to 6.56), ASA III and above (OR, 2.62; 95% CI, 1.27 to 3.68), long-term use of aspirin (OR, 3.63; 95% CI, 1.41 to 4.78), and elevated RDW level (each increment of 1%, OR, 1.21; 95% CI, 1.02 to 1.36) were independently associated with postoperative stroke. Conclusions Although most are not modifiable, these risk factors help in counseling patients regarding the risk of postoperative stroke, individual risk stratification, and targeted optimization of medical conditions and should be firmly kept in treating surgeon’s mind.

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