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Stubbs TA, Doherty WJ, Chaplin A, Langford S, Reed MR, Sayer AA, Witham MD, Sorial AK. Using pre-fracture mobility to augment prediction of post-operative outcomes in hip fracture. Eur Geriatr Med 2023; 14:285-293. [PMID: 37002428 PMCID: PMC10113355 DOI: 10.1007/s41999-023-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
Abstract
Purpose
Pre-operative scores based on patient characteristics are commonly used to predict hip fracture outcomes. Mobility, an indicator of pre-operative function, has been neglected as a potential predictor. We assessed the ability of pre-fracture mobility to predict post-operative outcomes following hip fracture.
Methods
We analysed prospectively collected data from hip fracture surgery patients at a large-volume trauma unit. Mobility was classified into four groups. Post-operative outcomes studied were mortality and residence at 30 days, medical complications within 30- or 60-days post-operatively, and prolonged length of stay (LOS, ≥ 28 days). We performed multivariate regression analyses adjusting for age and sex to assess the discriminative ability of the Nottingham Hip Fracture Score (NHFS), with and without mobility, for predicting outcomes using the area under the receiver operating characteristic curve (AUROC).
Results
1919 patients were included, mean age 82.6 (SD 8.2); 1357 (70.7%) were women. Multivariate analysis demonstrated patients with worse mobility had a 1.7–5.5-fold higher 30-day mortality (p ≤ 0.001), and 1.9–3.2-fold higher likelihood of prolonged LOS (p ≤ 0.001). Worse mobility was associated with a 2.3–3.8-fold higher likelihood of living in a care home at 30-days post-operatively (p < 0.001) and a 1.3–2.0-fold higher likelihood of complications within 30 days (p ≤ 0.001). Addition of mobility improved NHFS discrimination for discharge location, AUROC NHFS 0.755 [0.733–0.777] to NHFS + mobility 0.808 [0.789–0.828], and LOS, AUROC NHFS 0.584 [0.557–0.611] to NHFS + mobility 0.616 [0.590–0.643].
Conclusion
Incorporating mobility assessment into risk scores may improve casemix adjustment, prognostication following hip fracture, and identify high-risk patient groups requiring enhanced post-operative care at admission.
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Affiliation(s)
- Thomas A Stubbs
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - William J Doherty
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - Andrew Chaplin
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Sarah Langford
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Mike R Reed
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK.
| | - Antony K Sorial
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK.
- Institute for Cell and Molecular Biosciences, Newcastle University, International Centre for Life, Newcastle Upon Tyne, NE1 3BZ, UK.
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Development and Validation of a New Tool in Predicting In-Hospital Mortality for Hip-Fractured Patients: The PRIMOF Score. Medicina (B Aires) 2022; 58:medicina58081082. [PMID: 36013549 PMCID: PMC9412693 DOI: 10.3390/medicina58081082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The improved life expectancy was associated to the increased in the incidence of hip fractures among elderly people. Subjects suffering hip fractures frequently show concomitant conditions causing prolonged lengths of stay and higher in-hospital mortality. The knowledge of factors associated to in-hospital mortality or adverse events can help healthcare providers improve patients’ outcomes and management. The aim of this study was to develop a score to predict in-hospital mortality among hip fractured patients. Materials and Methods: Cases were selected from hospital admissions that occurred during the period 2006–2015 in Abruzzo region, Italy. The study population was split into two random samples in order to evaluate the accuracy of prediction models. A multivariate logistic regression was performed in order to identify factors associated to in-hospital mortality. All diagnoses significantly associated to in-hospital mortality were included in the final model. Results: The PRIMOF ranged between 0 and 27 and was divided into four risk categories to allow the score interpretation. An increase in odds ratio values with the increase in PRIMOF score was reported in both study groups. Conclusions: This study showed that a simple score based on the patient’ clinical comorbidities was able to stratify the risk of hip-fractured patients in terms of in-hospital mortality.
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