1
|
Sun Y, Liu Y, Zhu Y, Luo R, Luo Y, Wang S, Feng Z. Risk prediction models of mortality after hip fracture surgery in older individuals: a systematic review. Curr Med Res Opin 2024; 40:523-535. [PMID: 38323327 DOI: 10.1080/03007995.2024.2307346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE This study aimed to critically assess existing risk prediction models for postoperative mortality in older individuals with hip fractures, with the objective of offering substantive insights for their clinical application. DESIGN A comprehensive search was conducted across prominent databases, including PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP, and Wanfang, spanning original articles in both Chinese and English up until 1 December 2023. Two researchers independently extracted pertinent research characteristics, such as predictors, model performance metrics, and modeling methodologies. Additionally, the bias risk and applicability of the incorporated risk prediction models were systematically evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS Within the purview of this investigation, a total of 21 studies were identified, constituting 21 original risk prediction models. The discriminatory capacity of the included risk prediction models, as denoted by the minimum and maximum areas under the subject operating characteristic curve, ranged from 0.710 to 0.964. Noteworthy predictors, recurrent across various models, included age, sex, comorbidities, and nutritional status. However, among the models assessed through the PROBAST framework, only one was deemed to exhibit a low risk of bias. Beyond this assessment, the principal limitations observed in risk prediction models pertain to deficiencies in data analysis, encompassing insufficient sample size and suboptimal handling of missing data. CONCLUSION Subsequent research endeavors should adopt more stringent experimental designs and employ advanced statistical methodologies in the construction of risk prediction models. Moreover, large-scale external validation studies are warranted to rigorously assess the generalizability and clinical utility of existing models, thereby enhancing their relevance as valuable clinical references.
Collapse
Affiliation(s)
- Ying Sun
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Yaning Zhu
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Ruzhen Luo
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yiwei Luo
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zihang Feng
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| |
Collapse
|
2
|
Mohammed H, Parks M, Ibrahim S, Magnus M, Ma Y. Impact of Pre-operative Opioid Use on Racial Disparities in Adverse Outcomes Post Total Knee and Hip Arthroplasty. J Racial Ethn Health Disparities 2023; 10:3051-3061. [PMID: 36478270 DOI: 10.1007/s40615-022-01479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The growing opioid epidemic in the USA has underlying racial disparities dimensions. Also, studies have shown that patients from minority racial groups are at higher risk of adverse events following major orthopedic surgery. The aim of our study was to determine whether pre-operative opioid-use disorders (OUDs) impacted racial disparities in the likelihood of patients experiencing adverse post-operative outcomes following TKA and THA. METHODS Data about patients undergoing TKA and THA were collected from the 2005-2014 National Inpatient Sample databases. Regression modeling was used to assess the impact of OUDs on odds of adverse outcomes comparing racial groups. The adverse outcomes included any in-hospital post-surgical complications, prolonged length of stay (LOS), and nonhome discharge. RESULTS In our fully adjusted regression models using White patients as the reference group, we found that OUDs were associated with racial disparities in prolonged LOS and nonhome discharge. In the non-OUD group, Black patients had significantly higher odds of longer LOS (OR: 1.35, 95% CI: 1.26-1.46, p-value: < 0.0001), whereas those with history of OUD had non-significantly lower odds of longer LOS (OR: 0.94, 95% CI: 0.69-1.29, p-value: 0.71). Similarly, for the outcome of nonhome discharges, Black patients in the non-OUD group had significantly higher odds (OR: 1.31, 95% CI: 1.21-1.43, p-value: < 0.0001) and those with a history of OUD had non-significantly lower odds (OR: 0.91, 95% CI: 0.64-1.29, p-value: 0.59). CONCLUSIONS Significant racial disparities are present in adverse events among patients in the non-OUD group, but those disparities attenuated in the OUD group.
Collapse
Affiliation(s)
- Hina Mohammed
- Syapse Inc., San Francisco, CA, USA
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Michael Parks
- Hospital for Special Surgery, New York City, NY, USA
- Weill Cornell Medical College, Cornell University, New York City, NY, USA
| | - Said Ibrahim
- Donal and Barbara Zucker School of Medicine, Northwell Health/ Hofstra University, Long Island, NY, USA
| | - Manya Magnus
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Yan Ma
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
3
|
Vahapoğlu A, Çavuş Z, Korkan F, Özakin O, Türkmen ÜA. Is a guideline required to predict the intensive care unit need of patients over 65 years of age during the pre-operative period? A comparison of the American Society of Anesthesiologists, lung ultrasound score, Charlson age-added comorbidity index, surgi. ULUS TRAVMA ACIL CER 2023; 29:1004-1012. [PMID: 37681718 PMCID: PMC10560819 DOI: 10.14744/tjtes.2023.43082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND All pre-operative, intra-operative, and post-operative variables of the patients at 65 years of age who had a surgi-cal procedure determine the necessity of post-operative intensive care unit (ICU) monitoring. The indication for post-operative ICU is detected through ideal scoring systems related to the surgery and anesthesia that will be performed easily and fast would prevent the development of morbidity and mortality in high-risk patients. In the present study, we compared the efficacy of the American Society of Anesthesiologists (ASA) score, lung ultrasound score (LUSS), Charlson age-added comorbidity index (CACI), and surgical outcome risk tool (SORT) score of the indication for ICU. The hypothesis of our study is to show that real visual LUSS is superior to the screening test SORT, CACI, and the other score, ASA, for ICU indication determination. METHODS The study enrolled 101 patients over 65 years of age who will have surgical procedures under elective conditions. De-mographic features, clinical parameters, ICU indications, ASA, LUSS, CACI, and SORTs of the patients were calculated prospectively and recorded. The effects of patients' ASA, LUSS, CACI, and SORT on determining the need for postoperative ICU admission were examined. RESULTS The age of patients who needed post-operative ICU admission was significantly higher than those who did not need post-operative ICU admission (P<0.001). The groups did not show differences in terms of gender, body mass index, smoking, and type of anesthesia (P>0.05). ASA, LUSS, CACI, and SORT were significantly higher for patients who needed post-operative ICU admission (P<0.001). The proportion of patients who needed post-operative ICU admission was higher for patients with post-operative ICU indication (P<0.001). The number of consultations was significantly higher for patients who needed post-operative ICU admission (P<0.001). SORT was found to be the highest accuracy for predicting the need for post-operative ICU admission. CONCLUSION It was detected that ASA, LUSS, CACI, and SORT are effective for the determination of the ICU indication in the pre-operative evaluation process of patients over the age of 65 who had elective surgery. However, the efficiency of SORT was found to be superior to the others.
Collapse
Affiliation(s)
- Ayşe Vahapoğlu
- Department of Anesthesiology and Reanimation Clinic, Health Sciences University Gaziosmanpaşa Training and Research Hospital, İstanbul-Türkiye
| | - Zuhal Çavuş
- Department of Anesthesiology and Reanimation Clinic, Health Sciences University Gaziosmanpaşa Training and Research Hospital, İstanbul-Türkiye
| | - Fatma Korkan
- Department of Anesthesiology and Reanimation Clinic, Health Sciences University Gaziosmanpaşa Training and Research Hospital, İstanbul-Türkiye
| | - Oğuz Özakin
- Department of Anesthesiology and Reanimation Clinic, Health Sciences University Gaziosmanpaşa Training and Research Hospital, İstanbul-Türkiye
| | - Ülkü Aygen Türkmen
- Department of Anesthesiology and Reanimation Clinic, Health Sciences University Gaziosmanpaşa Training and Research Hospital, İstanbul-Türkiye
| |
Collapse
|
4
|
Zhang DL, Cong YX, Zhuang Y, Xu X, Zhang BF. Age-adjusted Charlson comorbidity index predicts postoperative mortality in elderly patients with hip fracture: A prospective cohort. Front Med (Lausanne) 2023; 10:1066145. [PMID: 36960340 PMCID: PMC10027731 DOI: 10.3389/fmed.2023.1066145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
Background This study aimed to evaluate the clinical association between the age-adjusted Charlson comorbidity index (aCCI) and postoperative mortality in elderly patients. Materials and methods Elderly patients with hip fractures were screened from January 2015 to September 2019. After demographic and clinical characteristics were collected, linear and non-linear multivariate Cox regression models were used to identify the association between the aCCI and mortality. All analyses were performed using EmpowerStats and R software. Results A total of 2,657 patients were included in the study, and the mean follow-up duration was of 38.97 months. The mean aCCI score was 4.24 ± 1.09, and 977 (34.14%) died of all-cause mortality. The fully-adjusted linear multivariate Cox regression models showed the aCCI to be associated with mortality [hazard ratio (HR) = 1.31, 95% confidence interval (CI):1.21-1.41, P < 0.0001]. Patients in Q2 showed greater mortality (HR = 1.60, 95% CI: 1.23-2.09; P = 0.0005) than those in Q1; patients in Q3 showed greater mortality (HR = 2.18, 95% CI: 1.66-2.87; P < 0.001) than those in Q1. In addition, the P-value for the trend also showed a linear association in the three models (P < 0.0001). In the sensitivity analysis, propensity score matching was used, and the results were stable. Conclusion The mortality risk of hip fractures increased by 31% when the aCCI increased by one unit. aCCI score was shown to be a good predictor of three-year mortality following hip fracture. Clinical trial registration http://www.chictr.org.cn/showproj.aspx?proj=152919, identifier ChiCTR2200057323.
Collapse
Affiliation(s)
- Dan-Long Zhang
- Department of Trauma and Orthopedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yu-Xuan Cong
- Department of Trauma and Orthopedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yan Zhuang
- Department of Trauma and Orthopedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xin Xu
- Department of Trauma and Orthopedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- *Correspondence: Xin Xu,
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Bin-Fei Zhang,
| |
Collapse
|
5
|
Lu Y, Huang Q, Xu Y, Ren C, Sun L, Dong W, Li M, Xue H, Li Z, Zhang K, Ma T, Wang Q. Predictors of long-term mortality after intertrochanteric fractures surgery: a 3-year retrospective study. BMC Musculoskelet Disord 2022; 23:472. [PMID: 35590357 PMCID: PMC9118842 DOI: 10.1186/s12891-022-05442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Intertrochanteric fractures are associated with high mortality rates; however, long-term data on survival and predictors remain scarce. Therefore, this study investigated risk factors associated with 3-year mortality in elderly patients with intertrochanteric fractures. Methods In a retrospective study, 156 elderly patients with intertrochanteric fractures who underwent surgery between January 2017 to January 2018 at our center were included. Association-affecting variables, such as gender, age, time from injury to surgery, hemoglobin (Hb), total lymphocyte count (TLC), albumin, malnutrition, and co-morbidities, were recorded and analyzed. Afterward, logistic regression was used to analyze the significant variables and find independent predictors for 3-year mortality. Results A total of 156 patients were followed up for 3 years. The 1-year, 2-year, and 3-year postoperative cumulative mortality rates were 9.6% (15/156), 16.7% (26/156), and 24.4% (38/156), respectively. Simple analyses found that age, Hb, albumin, and malnutrition were associated with 3-year mortality (p < 0.05). Multivariable analysis confirmed that advanced age (p < 0.001) and low albumin (p = 0.014) were independent risk factors for 3-year mortality. Conclusion Low serum albumin and advanced age were independent risk factors for long-term mortality in elderly patients with intertrochanteric fractures. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05442-2.
Collapse
Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Yibo Xu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Wenchao Dong
- Shaanxi University of Chinese Medicine, Xian yang, 710000, Shaanxi, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China.
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaan'xi Province, China.
| |
Collapse
|