The Charlson and Elixhauser Scores Outperform the American Society of Anesthesiologists Score in Assessing 1-year Mortality Risk After Hip Fracture Surgery

Background: The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo–Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. Methods and Material: A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015. Age, gender, time to surgery, ASA-PS score, D-CCI, and CARES score were obtained. Univariate and multivariable logistic regression analyses were used to assess statistical significance of scores and risk factors, and area under the receiver operating characteristic (ROC) curve (AUC) was used to compare ASA-PS, D-CCI, and CARES as predictors of mortality at 2 years. Results: 763 surgically treated hip fracture patients were included in this study. The 2-year mortality rate was 13.1% (n = 100), and the mean ± SD CARES score of surviving and demised patients was 21.2 ± 5.98 and 25.9 ± 5.59, respectively. Using AUC, CARES was shown to be a better predictor of 2-year mortality than ASA-PS, but we found no statistical difference between CARES and D-CCI. A CARES score of 23, attributable primarily to pre-surgical morbidities and poor health of the patient, was identified as the statistical threshold for “high” risk of 2-year mortality. Conclusion: The CARES score is a viable risk predictor for 2-year mortality following hip fracture surgery and is comparable to the D-CCI in predictive capability. Our results support the use of a simpler yet clinically relevant CARES in prognosticating mortality following hip fracture surgery, particularly when information on the pre-existing comorbidities of the patient is not immediately available.

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A novel machine-learning algorithm for predicting mortality risk after hip fracture surgery

Injury ◽

10.1016/j.injury.2020.12.008 ◽

2020 ◽

Author(s):

Yi Li ◽

Ming Chen ◽

Houchen Lv ◽

Pengbin Yin ◽

Licheng Zhang ◽

...

Keyword(s):

Machine Learning ◽

Hip Fracture ◽

Mortality Risk ◽

Learning Algorithm ◽

Machine Learning Algorithm ◽

Hip Fracture Surgery ◽

Fracture Surgery

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Short-term complications of anesthetic technique used in hip fracture surgery in elderly people

European Journal of Translational Myology ◽

10.4081/ejtm.2018.7355 ◽

2018 ◽

Vol 28 (3) ◽

Cited By ~ 1

Author(s):

Afsaneh Norouzi ◽

Fozhan Behrouzibakhsh ◽

Alireza Kamali ◽

Bijan Yazdi ◽

Babak Ghaffari

Keyword(s):

Hip Fracture ◽

Vital Signs ◽

Cross Sectional Study ◽

Anesthetic Technique ◽

Sectional Study ◽

Short Term ◽

Cross Sectional ◽

Hip Fracture Surgery ◽

American Society ◽

Fracture Surgery

Postoperative complications of fracture are one of the main problems in older patients with hip fracture. In this study, complications were observed 48 hours after surgery in different anesthetic procedures. This prospective cross sectional study was carried out over a 12-month period. All subjects over 55 years of age undergoing hip fracture surgery were selected for study with ASA class (American Society of Anesthesiology: one, two and three). After determining the vital signs in the operating room, anesthesia type (general, spinal and epidural) and various variables were recorded. It was observed that the spinal anesthesia method had the lowest level of postoperative disturbances of consciousness and had the shortest duration in terms of duration of time. On the other hand, general anesthesia was the least in terms of blood transfusion. Finally, epidural anesthetic method showed the least amount of pain 48 hours after operation and the least changes in blood pressure and heart rate.

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Variation in timely surgery for hip fracture by day and time of presentation: a nationwide prospective cohort study from the National Hip Fracture Database for England, Wales and Northern Ireland

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-011196 ◽

2020 ◽

pp. bmjqs-2020-011196

Author(s):

Anjali Shah ◽

Gulraj S Matharu ◽

Dominic Inman ◽

Elizabeth Fagan ◽

Antony Johansen ◽

...

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Northern Ireland ◽

Population Based ◽

Quality Healthcare ◽

Adjusted Risk ◽

Hip Fracture Surgery ◽

Average Patient ◽

American Society ◽

American Society Of Anesthesiologists

Background and ObjectiveSeveral studies report poorer quality healthcare for patients presenting at weekends. Our objective was to examine how timely surgery for patients with hip fracture varies with day and time of their presentation.MethodsThis population-based cohort study used 2017 data from the National Hip Fracture Database, which recorded all patients aged 60 years and over who presented with a hip fracture at a hospital in England, Wales and Northern Ireland. Provision of prompt surgery (surgery within 36 hours of presentation) was examined, using multivariable logistic regression with generalised estimating equations to derive adjusted risk ratios (RRs). Time was categorised into three 8-hour intervals (day: 08:00–15:59, evening: 16:00–23:59 and night: 00:00–07:59) for each day of the week. The model accounted for clustering by hospital and was adjusted by sex, age, fracture type, operation type, American Society of Anesthesiologists grade, preinjury mobility and location.ResultsWe studied 68 977 patients from 177 hospitals. The average patient presenting during the day on Friday or Saturday was significantly less likely to undergo prompt surgery (Friday during 08:00–15:59, RR=0.93, 95% CI 0.91 to 0.96; Saturday during 08:00–15:59, RR=0.91, 95% CI 0.88 to 0.94) than patients in the comparative category (Thursday, during the day). Patients presenting during the evening (16:00–23:59) were consistently significantly less likely to undergo prompt surgery, and the effect was more marked on Fridays and Saturdays (Friday during 16:00-23:59, RR=0.83, 95% CI 0.80 to 0.85; Saturday during 16:00–23:59, RR=0.81, 95% CI 0.78 to 0.85). Patients presenting overnight (00:00–07:59), except on Saturdays, were significantly more likely to undergo surgery within 36 hours (RR>1.07).ConclusionThe provision of prompt hip fracture surgery was complex, with evidence of both an ‘evening’ and a ‘night’ effect. Investigation of weekly variation in hip fracture care is required to help implement strategies to reduce the variation in timely surgery throughout the entire week.

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No Major Differences in Recovery After Hip Fracture Between Home-Dwelling Female and Male Patients

Scandinavian Journal of Surgery ◽

10.1177/1457496919847932 ◽

2019 ◽

Vol 109 (3) ◽

pp. 250-264

Author(s):

A. Lahtinen ◽

J. Leppilahti ◽

H. Vähänikkilä ◽

S. Kujala ◽

J. Ristiniemi ◽

...

Keyword(s):

Hip Fracture ◽

Activities Of Daily Living ◽

Mortality Risk ◽

Daily Living ◽

Walking Ability ◽

Residential Status ◽

Men And Women ◽

Male Patients ◽

American Society ◽

American Society Of Anesthesiologists

Background: Studies comparing recovery of men and women after hip fracture have reported conflicting results, some reporting worse recovery in male patients, while others found no differences between genders. Methods: Recovery was compared in 105 male and 433 female patients with hip fractures and in age-matched groups of patients 50 years or older, who were home-dwelling and received similar rehabilitation. Residential status, walking ability, hip pain and activities of daily living function were recorded at admission and 4 and 12 months postoperatively, along with mortality and re-operations. Results: No differences were observed between men and women 4 and 12 months postoperatively regarding residential status (p = 0.181 vs p = 0.883), mortality rates (p = 0.232 vs p = 0.880) or total activities of daily living scores (p = 0.546 vs p = 0.435). Walking ability was better among male patients prefracture (p < 0.001) and 4 and 12 months after fracture (p < 0.001, p = 0.031, respectively). In age-matched pair analysis, no differences were found regarding mortality, residential status, walking ability, or ADL score. Cox regression analysis identified mortality risk factors as being age, prefracture ADL score, American Society of Anesthesiologists score 4–5 and place of rehabilitation. Sex was not mortality risk factor. Interpretation: Home-dwelling male and female patients had similar courses of recovery from hip fracture, although there were singular differences in specific activities of daily living functions and postoperative pain. There were no differences in mortality, even when prefracture characteristics were considered. Mortality was higher among older patients and who had high American Society of Anesthesiologists scores and low prefracture activities of daily living scores.

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