Formulating a preoperative risk scoring system for elderly patients with hip fracture / 中华创伤骨科杂志

ABSTRACT

Objective To establish a preoperative risk scoring system for elderly patients with hip fracture on the basis of investigation into the factors influencing their mortality during hospitalization. Methods The data were collected from the database of hospitalization summary reports ( HSR ) of Beijing Public Health Commission concerning the 14, 577 patients who had been 55 years old or older and hospitalized for hip fracture from January 1, 2006 throughout December 31, 2010 at the 35 top-rank hospitals in Beijing. They were divided into a surgery group and a non-surgery group. Two multivariable risk-adjustment models were established for the 2 groups on the basis of an investigation into the factors influencing their mor-tality during hospitalization. Finally a preoperative risk scoring system for elderly patients with hip frac-ture was formulated according to the valuation of the least common multiples of β coefficients of the risk factors.Results Besides senior age and male gender, 10 different comorbidities were independently associated with in-hospital mortality, particularly pulmonary embolism, respiratory failure, renal failure and diabetes. The risk for inpatient mortality associated with a specific comorbidity was relatively higher in the surgery group than in the non-surgery group. The risk-adjustment models based on the variables had better accuracy in predicting in-hospital mortality ( ROC＝0.91 in surgery group versus ROC＝0.85 in non-surgery group ). In our preoperative risk scoring system for elderly patients with hip fracture, 10 points were for an age of 65 to 74 years old, 14 points for an age of 75 to 84 years old, 18 points for an age beyond 85 years old, 4 points for male gender, 20 points for pulmonary embolism, 18 points for respiratory failure, 10 points for renal insufficiency, 8 points for diabetes, 8 points for heart failure, 7 points for malignant tumor, 7 points for lung infection, 7 points for disturbance of water, electrolyte and acid-base balance, 6 points for arrhythmia, and 6 points for cerebral infarction, totaling 119 points. Conclusions The primary risk factors for in-hospital mortality in the elderly patients with hip fracture seem to be senior age, male gender and 10 different comorbidi-ties. A preoperative risk scoring system has been successfully established for elderly patients with hip fracture.