The Interaction Between Per-admission β-Blocker Therapy, The Revised Cardiac Risk Index, and Mortality in Geriatric Hip Fracture Patients

Abstract Purpose The post-operative mortality after hip fracture surgery is high and has remained largely unchanged during the last decades. The Revised Cardiac Risk Index (RCRI) is a tool used to evaluate the 30-day risk of, among other outcomes, post-operative mortality. The aim of this study is to determine the association between the RCRI score and post-operative mortality in patients undergoing hip fracture surgery. Methods Data was obtained from the national hip fracture register which was cross-referenced with patients’ electronic hospital records. All adults who underwent primary emergency hip fracture surgery in Orebro County, Sweden, between January 1, 2013 and December 31, 2017, were included. Patients were divided into two cohorts: low RCRI (score = 0–1) and high RCRI (score ≥ 2). A Poisson regression model was employed to investigate the association between a high RCRI score and 30- and 90-day post-operative mortality. Results A total of 2443 patients, of whom 446 (18%) had a high RCRI score, were included in the current study. When adjusting for age, sex, comorbidities and type of surgery, the incidence of 30-day mortality increased by 46% in the high RCRI cohort (adj. IRR 1.46, 95% CI, 1.10–1.94, p = 0.010). Similar results were observed for 90-day mortality (adj. IRR 1.50, 95% CI, 1.21–1.84, p < 0.001). Conclusion The RCRI is applicable to patients that undergo surgery for traumatic hip fractures. A high RCRI score is associated with an increased incidence of both 30- and 90-day post-operative mortality. Future studies to evaluate these findings are needed.

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P6252Diagnostic and prognostic accuracy of preoperative NT-proBNP added to revised cardiac risk index in elderly patients with hip fracture

European Heart Journal ◽

10.1093/eurheartj/ehz746.0852 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

I Iglesias Garriz ◽

M D Ruiz-Villa ◽

J Idoate ◽

S Jimenez Mola ◽

A Sanchez-Robles ◽

...

Keyword(s):

Hip Fracture ◽

Risk Index ◽

Positive Likelihood Ratio ◽

Cardiac Risk ◽

Clinical Value ◽

Predictive Values ◽

Prognostic Accuracy ◽

Net Reclassification Improvement ◽

Cardiac Risk Index ◽

C Statistic

Abstract Background The identification of patients at highest risk after surgery for hip fracture could be of clinical value to implement post-operative actions to lessen mortality. We sought to investigate the utility of Revised Cardiac Risk Index (RCRI) and NT-proBNP in this scenario. Methods Patients older than 75 years with hip fracture treated with surgery were prospectively included. The end-point was overall mortality at 30 days. Results We enrolled 410 patients surgically-treated for hip fracture, 31 (7.6%) died during the 30-day follow-up. Patients who died were 3.5 years older (95% CI 1.3 to 5.6); p=0.001, and had a lower prevalence of diabetes mellitus.The prevalence of heart failure was more prevalent among patients who died: difference of proportions 35.7% (95% CI 16.0 to 55.3); p<0.001 and more patients were not in sinus rhythm with a difference of 25.4% (95% CI 5.6 to 45.1); p<0.001. Adding NT-proBNP to a logistic regression model with RCRI as an independent variable, improved the diagnostic and prognostic metrics, with significant changes in specificity (0.59 vs 0.70, p<0.001) and predictive values: positive likelihood ratio (LR) 1.89 vs 2.49, p<0.001, negative LR 0.38 vs 0.33, p<0.001. The C-statistic (0.69 vs 0.77, p=0.002) and the net reclassification improvement were also improved. Conclusion Adding preoperative NT-proBNP to RCRI to appraise the risk of overall 30-day mortality rate after hip surgery improves the prediction accuracy of RCRI alone.

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Postoperative mortality in hip fracture patients stratified by the Revised Cardiac Risk Index: a Swedish nationwide retrospective cohort study

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000778 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000778

Author(s):

Maximilian Peter Forssten ◽

Ahmad Mohammad Ismail ◽

Tomas Borg ◽

Rebecka Ahl ◽

Per Wretenberg ◽

...

Keyword(s):

Hip Fracture ◽

Risk Index ◽

Postoperative Mortality ◽

Cardiac Risk ◽

Significant Linear Trend ◽

Hip Fracture Surgery ◽

Cardiac Risk Index ◽

Postoperative Myocardial Infarction ◽

National Quality ◽

Fracture Surgery

ObjectivesThe Revised Cardiac Risk Index (RCRI) is a tool that can be used to evaluate the 30-day risk of postoperative myocardial infarction, cardiac arrest and mortality. This study aims to confirm its association with postoperative mortality in patients who underwent hip fracture surgery.MethodsAll adults who underwent primary emergency hip fracture surgery in Sweden between January 1, 2008 and December 31, 2017 were included in this study. The database was retrieved by cross-referencing the Swedish National Quality Register for hip fractures with the Swedish National Board of Health and Welfare registers. The outcomes of interest were the association between the RCRI score and mortality at 30 days, 90 days and 1 year postoperatively.Results134 915 cases were included in the current study. There was a statistically significant linear trend in postoperative mortality with increasing RCRI scores at 30 days, 90 days and 1 year. An RCRI score ≥4 was associated with a 3.1 times greater risk of 30-day postoperative mortality (adjusted incidence rate ratio (IRR) 3.13, p<0.001), a 2.5 times greater risk of 90-day postoperative mortality (adjusted IRR 2.54, p<0.001) and a 2.8 times greater risk of 1-year postoperative mortality (adjusted HR 2.81, p<0.001) compared with that observed with an RCRI score of 0.ConclusionAn increasing RCRI score is strongly associated with an elevated risk 30-day, 90-day and 1-year postoperative mortality after primary hip fracture surgery. The objective and easily retrievable nature of the variables included in the RCRI calculation makes it an appealing choice for risk stratification in the clinical setting.Levels of evidenceLevel III.

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