A Prediction Modeling Based on the Hospital for Special Surgery (HSS) Knee Score for Poor Postoperative Functional Prognosis of Elderly Patients with Patellar Fractures

Background. The main aim of this study was to develop a nomogram prediction model for poor functional prognosis after patellar fracture surgery in the elderly based on the hospital for special surgery (HSS) knee score. Methods. A retrospective analysis of 168 elderly patients with patellar fractures was performed to collect demographic data, knee imaging, and functional prognosis preoperatively and during the 6-month postoperative follow-up period. Good functional prognosis of knee joint was defined as the percentage of HSS knee scores on the injured side relative to the uninjured side ≥ 80 % at six-month postoperative review. Multifactorial linear regression analysis and logistic regression analysis were then used to identify risk factors of functional prognosis and develop the nomogram prediction model. Furthermore, the validity and accuracy of the prediction model were evaluated using C-index, area under the curve (AUC), and decision curve analyses. Results. The final screening from the 12 potential risk factors yielded three high-risk factors which were included in the nomogram prediction model: advanced age (OR 0.28 (95% CI 0.11-0.67), P = 0.005 ), sarcopenia (OR 0.11 (95% CI 0.05-0.26), P < 0.001 ), and low albumin level (OR 1.14 (95% CI 1.02-1.29), P = 0.025 ). The model had a good predictive ability with an AUC of 0.857 (95% CI (0.783-0.929)) for the training group and a C-index of 0.836 for the overall sample. In addition, the decision analysis curve indicated that the model had good clinical applicability. Conclusion. Our predictive model is effective in predicting the risk of poor functional prognosis after patellar fracture surgery in the elderly by assessing high-risk factors such as advanced age, sarcopenia, and serum albumin levels. This prediction model can help clinicians to make individualized risk prediction, early identification of patients at high risk for poor functional outcome, and appropriate interventions.

EP.FRI.948 Outcomes Following Emergency Laparotomy In The Over 70’s

Aim Surgery in the elderly carries greater risk of mortality with those who are frail being most at risk. We aimed to review our outcomes for patients 70 years of age and over, who underwent emergency laparotomy. Methods All patients aged 70 and over who had undergone emergency laparotomy within a 12-month period were included for analysis. Patient’s pre-operative risk was assessed by the P-Possum and NELA scoring along with Rockwood Frailty Scale (RFS) and the Geriatric rescue after surgery (GRAS) score. Results 50/116 patients undergoing emergency laparotomy were aged over 70 years old. Full data was available for 47 of these. Overall 30- and 90-day mortality was 12.8% and 21.3% respectively. 90-day mortality in patients with a RFS of &gt; 4 was 25% compared with 16% with a score of 4 or less. Those with a GRAS score &lt;4 and 4 or greater had a 90-day mortality of 16% and 27% respectively. Where there was a P-Possom mortality risk &gt;10% was no difference in the mortality rates, however when the NELA risk was &gt;10%, 90 day mortality was 26.6% compared with 15.4%. Conclusion Emergency laparotomy in the over 70’s carries much higher risk of death. Mortality risk scoring and frailty assessments are useful tools in counselling patients and their families prior to surgery. Future work will assess the predictive value of different and combined scores in this population.

Surgical treatment of senile spinal diseases

Advanced age is a well-known risk factor for spinal surgery-related complications. Decisions on spine surgery in the elderly are difficult due to higher morbidity and mortality than in younger age groups. In addition, spine surgery is a kind of ‘functional surgery’ which does not directly affect the survival of patients. In recent years, individualized risk stratification has gained ground over simple chronological age-based assessment. In the elderly, frailty is one of the strongest factors which affect surgical outcomes for both cervical and thoracolumbar spine surgery, regardless of the surgical technique used. Spine surgery in the elderly have worse surgical outcomes in terms of duration of hospital stay, degree of functional recovery, and complication, readmission, and mortality rates. However, the benefit of spine surgery even in the very-elderly is substantial. In conclusion, surgical decisions should be made based on both personalized risk assessment and benefits of surgery. Recent advanced surgical techniques such as minimally invasive surgical techniques and robotics assistance are likely to be helpful in minimizing surgical complications. Therefore, advanced age in itself should not be considered as a contraindication for spine surgery.