scholarly journals Predictive Values of Preoperative Characteristics for 30-Day Mortality in Traumatic Hip Fracture Patients

2021 ◽  
Vol 11 (5) ◽  
pp. 353
Author(s):  
Yang Cao ◽  
Maximilian Peter Forssten ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Ioannis Ioannidis ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Risk Index ◽  
Postoperative Mortality ◽  
Predictive Ability ◽  
Cardiac Risk ◽  
Predictive Values ◽  
Hip Fracture Surgery ◽  
Asa Classification ◽  
Risk Of Mortality ◽  
Fracture Surgery

Hip fracture patients have a high risk of mortality after surgery, with 30-day postoperative rates as high as 10%. This study aimed to explore the predictive ability of preoperative characteristics in traumatic hip fracture patients as they relate to 30-day postoperative mortality using readily available variables in clinical practice. All adult patients who underwent primary emergency hip fracture surgery in Sweden between 2008 and 2017 were included in the analysis. Associations between the possible predictors and 30-day mortality was performed using a multivariate logistic regression (LR) model; the bidirectional stepwise method was used for variable selection. An LR model and convolutional neural network (CNN) were then fitted for prediction. The relative importance of individual predictors was evaluated using the permutation importance and Gini importance. A total of 134,915 traumatic hip fracture patients were included in the study. The CNN and LR models displayed an acceptable predictive ability for predicting 30-day postoperative mortality using a test dataset, displaying an area under the ROC curve (AUC) of as high as 0.76. The variables with the highest importance in prediction were age, sex, hypertension, dementia, American Society of Anesthesiologists (ASA) classification, and the Revised Cardiac Risk Index (RCRI). Both the CNN and LR models achieved an acceptable performance in identifying patients at risk of mortality 30 days after hip fracture surgery. The most important variables for prediction, based on the variables used in the current study are age, hypertension, dementia, sex, ASA classification, and RCRI.

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

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.

scholarly journals The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

2020 ◽  
Author(s):  
Maximilian Peter Forssten ◽  
Ahmad Mohammad Ismail ◽  
Gabriel Sjolin ◽  
Rebecka Ahl ◽  
Per Wretenberg ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Operative Mortality ◽  
Risk Index ◽  
Cardiac Risk ◽  
Hip Fracture Surgery ◽  
Cardiac Risk Index ◽  
Short Term Mortality ◽  
Fracture Register ◽  
Fracture Surgery ◽  
Electronic Hospital

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.

scholarly journals Predicting 1-Year Mortality after Hip Fracture Surgery: An Evaluation of Multiple Machine Learning Approaches

2021 ◽  
Vol 11 (8) ◽  
pp. 727
Author(s):  
Maximilian Peter Forssten ◽  
Gary Alan Bass ◽  
Ahmad Mohammad Ismail ◽  
Shahin Mohseni ◽  
Yang Cao
Keyword(s):  
Hip Fracture ◽  
Area Under The Curve ◽  
Postoperative Mortality ◽  
Predictive Ability ◽  
Metastatic Carcinoma ◽  
Support Vector ◽  
Learning Approaches ◽  
Relative Importance ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Postoperative death within 1 year following hip fracture surgery is reported to be up to 27%. In the current study, we benchmarked the predictive precision and accuracy of the algorithms support vector machine (SVM), naïve Bayes classifier (NB), and random forest classifier (RF) against logistic regression (LR) in predicting 1-year postoperative mortality in hip fracture patients as well as assessed the relative importance of the variables included in the LR model. All adult patients who underwent primary emergency hip fracture surgery in Sweden, between 1 January 2008 and 31 December 2017 were included in the study. Patients with pathological fractures and non-operatively managed hip fractures, as well as those who died within 30 days after surgery, were excluded from the analysis. A LR model with an elastic net regularization were fitted and compared to NB, SVM, and RF. The relative importance of the variables in the LR model was then evaluated using the permutation importance. The LR model including all the variables demonstrated an acceptable predictive ability on both the training and test datasets for predicting one-year postoperative mortality (Area under the curve (AUC)= 0.74 and 0.74 respectively). NB, SVM, and RF tended to over-predict the mortality, particularly NB and SVM algorithms. In contrast, LR only over-predicted mortality when the predicted probability of mortality was larger than 0.7. The LR algorithm outperformed the other three algorithms in predicting 1-year postoperative mortality in hip fracture patients. The most important predictors of 1-year mortality were the presence of a metastatic carcinoma, American Society of Anesthesiologists (ASA) classification, sex, Charlson Comorbidity Index (CCI)≤ 4, age, dementia, congestive heart failure, hypertension, surgery using pins/screws, and chronic kidney disease.

scholarly journals Vitamin D Levels and Nutritional Risk Index: Mobility and Mortality After Hip Fracture Surgery (P01-013-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Lihong Hao ◽  
Yvette Schlussel ◽  
Jeffrey Carson ◽  
Sue Shapses
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Vitamin D Deficiency ◽  
Risk Index ◽  
Nutritional Risk ◽  
Walking Ability ◽  
Hip Fracture Surgery ◽  
Vitamin D Levels ◽  
Nutritional Risk Index ◽  
Fracture Surgery

Abstract Objectives Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. This study aims to determine whether 25-hydroxyvitamin D (25(OH)D) or the Geriatric Nutritional Risk Index (GNRI) is associated with short term mortality or ability to walk after hip fracture surgery. Methods Patients undergoing hip fracture repair were included in this study. Mortality and walking ability were assessed at 30 and 60 days after hip fracture surgery. Pre-operative serum albumin and 25(OH)D were measured. Patients were characterized with 25(OH)D <12 ng/mL, 12 to <20, 20 to <30 or ≥30. GNRI was calculated from albumin and body weight and patients were categorized into major/moderate nutritional risk (<92), low risk (92 to <98) or in good nutritional status (≥98). Results Of the 290 patients (82 ± 7 years, BMI 25 ± 5 kg/m2), 73% were females. Compared to patients with vitamin D deficiency (<12 ng/mL), those with vitamin D levels in higher categories had increased ability to walk at 30 days (P = 0.031): 12 to <20 ng/ml (adjusted odds ratio = 2.61; 95% confidence interval = 1.13–5.99); 20 to <30 ng/ml (3.48; 1.53–7.95); ≥30 ng/ml (2.84; 1.12–7.20). In addition, patients also had increased mobility at 60 days in these same higher vitamin D categories 12 to <20 (2.67; 1.14–6.25); 20 to <30 (3.42; 1.46–8.00); ≥30 ng/ml (3.67; 1.37–9.82) compared to the reference group (<12 ng/mL; P = 0.028). There was no association of vitamin D with mortality at either time point. GNRI was not associated with mortality or walking ability. Conclusions In patients with hip fracture, vitamin D deficiency (<12 ng/mL) was associated with reduced ambulation after surgery, whereas GNRI was not associated with any outcomes. Mechanisms that attenuate mobility due to vitamin D deficiency should be examined in future studies. Funding Sources ONE Nutrition Grant to SAS and JLC.

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

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.

Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study

2020 ◽  
pp. postgradmedj-2020-138679
Author(s):  
Vedat Çiçek ◽  
Tufan Cinar ◽  
Mert Ilker Hayiroglu ◽  
Şahhan Kılıç ◽  
Nürgül Keser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Cardiac Risk ◽  
Cardiac Risk Factors ◽  
Hip Fracture Surgery ◽  
Single Centre Study ◽  
Fracture Surgery

IntroductionIn the present study, our aim was to ascertain the preoperative cardiac risk factors related to the in-hospital mortality in the elderly patients (aged over 65 years) who required preoperative cardiology consultation for hip fracture surgery.Material and MethodsThe present study was a retrospective, single-centre study, which enrolled consecutive elderly patients without heart failure scheduled for hip fracture surgery in our institution. In all patients, an anesthesiologist performed a detailed preoperative evaluation and decided the need for the cardiac consultation. Patients underwent preoperative cardiac evaluation by a trained cardiologist using the algorithms proposed in the recent preoperative guidelines. The in-hospital mortality was the main outcome of the study.ResultsIn total, 277 elderly patients undergoing hip fracture surgery were enrolled in this analysis. The overall in-hospital mortality rate was 12.1% (n=30 cases). In a multivariate analysis, we found that insulin dependency, cancer, urea, presence of atrial fibrillation (AF) (OR: 3.906; 95% CI 1.470 to 10.381; p=0.006) and pulmonary artery systolic pressure (PASP) (OR: 1.057; 95% CI 1.016 to 1.100; p=0.006) were the predictors of in-hospital mortality. The receiver operating characteristic curve analysis revealed that the optimal value of PASP in predicting the in-hospital mortality was 35 mm Hg (area under the curve=0.71; 95% CI 0.60 to 0.81, p<0.001) with sensitivity of 87.7% and specificity of 59.5%.ConclusionThe present research found that the preoperative cardiac risk factors, namely AF and PASP, might be associated with increased in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery.

Perioperative Cardiac Morbidity in Elderly Patients with Epidural versus Systemic Analgesia for Hip Fracture Surgery

2014 ◽  
Vol 68 (2) ◽  
pp. 93-100
Author(s):  
Marina Temelkovska-Stevanovska ◽  
Trajkovska Trajanka ◽  
Maja Mojsova-Mijovska ◽  
Marija Jovanovski-Srceva
Keyword(s):  
Hip Fracture ◽  
Side Effects ◽  
Elderly Patients ◽  
Epidural Analgesia ◽  
Cardiac Risk ◽  
Cardiac Events ◽  
Cardiac Morbidity ◽  
Hip Fracture Surgery ◽  
Continuous Epidural Analgesia ◽  
Fracture Surgery

Abstract Introduction. Patients with hip fracture are usually older patients. Uncontrolled acute pain and surgical stress in elderly patients may cause increased cardiac morbidity and mortality. Epidural analgesia blocks sympathetic nervous system and reduces the incidence of myocardial ischemia and dysrhythmias as well as the response to stress. Methods. Sixty patients with hip fracture older than 65 years with previously defined high peroperative cardiac risk according to ACC/AHA guidelines were included and were randomly assigned to two groups of 30 patients: SA group-patients with systemic analgesia. niflam 2 × 100 mg/iv and tramadol 1 mg/kg/iv every 8 hours; and EDC group-patients with a continuous epidural analgesia with bupivacaine 0.125%-5 ml/h and fentanyl 3 µg/ml. As end points of the study the incidence of cardiac events in both groups were registered: cardiac death, myocardial infarction, congestive heart failure, unstable angina and new-onset atrial fibrillation. Laboratory parameters and pain intensity were determined in all patients by using Verbal Descriptive Scale. Side effects were also monitored. Results. The epidural analgesia decreased the incidence of peroperative cardiac events in patients with high per-operative cardiac risk for hip fracture surgery (46.6% in SA group vs. 15% in EDC group) and at the same time decreased cardiac mortality (10% in SA group vs. 0% in EDC group). The values of VDS were significantly lower in patients with EDC block versus patients with systemic analgesia in all experimental times and there was a smaller number of side effects. Conclusion. Early administration of continuous epidural analgesia in patients with high peroperative risk with hip fracture decreases the incidence of cardiac morbidity and mortality and provides superior pre- and post-operative analgesia compared to systemic analgesia with minimal side effects.

scholarly journals Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: a prospective study

2020 ◽  
Vol 112 (3) ◽  
pp. 613-618 ◽  
Author(s):  
Lihong Hao ◽  
Jeffrey L Carson ◽  
Yvette Schlussel ◽  
Helaine Noveck ◽  
Sue A Shapses
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Nutritional Status ◽  
Vitamin D Deficiency ◽  
Risk Index ◽  
Fracture Repair ◽  
Nutritional Risk ◽  
Hip Fracture Surgery ◽  
Nutritional Risk Index ◽  
Fracture Surgery

ABSTRACT Background Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. Objective This study aims to determine whether 25-hydroxyvitamin D [25(OH)D] concentration or the Geriatric Nutritional Risk Index (GNRI) is associated with mortality or rates of walking in a patient cohort after hip fracture surgery. Methods Patients undergoing hip fracture repair from a multisite study in North America were included. Mortality and mobility were assessed at 30 and 60 d after surgery. Serum albumin, 25(OH)D, and intact parathyroid hormone were measured. Patients were characterized according to 25(OH)D &lt;12 ng/mL, 12 to &lt;20 ng/mL, 20 to &lt;30 ng/mL, or ≥30 ng/mL. GNRI was categorized into major/moderate nutritional risk (&lt;92), some risk (92 to &lt;98), or in good nutritional status (≥98). Results Of the 290 patients [aged 82 ± 7 y, BMI (kg/m2): 25 ± 5], 73% were women. Compared with patients with &lt;12 ng/mL, those with higher 25(OH)D concentrations had higher rates of walking at 30 d (P = 0.031): 12 to &lt;20 ng/mL (adjusted OR: 2.61; 95% CI: 1.13, 5.99); 20 to &lt;30 ng/mL (3.48; 1.53, 7.95); ≥30 ng/mL (2.84; 1.12, 7.20). In addition, there was also greater mobility at 60 d (P = 0.028) in patients with higher 25(OH)D compared with the reference group (&lt;12 ng/mL). Poor nutritional status (GNRI &lt;92) showed an overall trend to reduce mobility (unadjusted P = 0.044 and adjusted P = 0.056) at 30 but not at 60 d. There was no association of vitamin D or GNRI with mortality at either time. Conclusions Vitamin D deficiency (&lt;12 ng/mL) is associated with reduced ambulation after hip fracture surgery, whereas GNRI also contributes to immobility but is a less reliable predictor. Mechanisms that can explain why vitamin D deficiency is associated with mobility should be addressed in future studies.

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