Geriatric Hip Fractures
A prediction model for postoperative 30-day complications in elderly patients with hip fracture based on a nomogram
Sun Fengpo, Liu Xiangxue, Zhang Ze, Zhang Tongyi, Ji Quan, Wen Liangyuan
Published 2023-09-15
Cite as Chin J Orthop Trauma, 2023, 25(9): 770-776. DOI: 10.3760/cma.j.cn115530-20230526-00265
Abstract
ObjectiveTo establish a visualized nomogram which can predict the rate of 30-day complications in the elderly patients after hip fracture.
MethodsA retrospective study was conducted to analyze the clinical data of 1,074 patients with hip fracture aged 60 years and over who had been admitted to Department of Orthopedics, Beijing Hospital from January 2010 to December 2017. There were 335 males and 739 females with an average age of (80.3±7.3) yeas, 529 intertrochanteric fractures of the femur (all fixed with intramedullary nails after closed reduction), and 545 femoral neck fractures (including 470 ones treated with artificial femoral head replacement and 75 ones treated with artificial total hip replacement). The duration between injury to operation was (6.2±3.7) d. After the complications within 30 days after surgery were recorded, the risk factors for postoperative complications were screened using the binary multi-factor logistic regression analysis. The visualized nomogram and calibration graph were established with the risk factors screened.
ResultsOf the 1,074 patients, 28.49% (306/1,074) suffered from 30-day complications. The multivariate regression analysis showed that age (OR=1.050, 95% CI: 1.022 to 1.080, P=0.001), time from injury to surgery (OR=1.043, 95% CI: 1.005 to 1.083, P=0.027), white blood cell count (OR=1.093, 95% CI: 1.033 to 1.158, P=0.002), serum albumin level (OR=0.930, 95% CI: 0.883 to 0.980, P=0.007), troponin I (OR=195.983, 95% CI: 2.224 to 17,268.296, P=0.021), respiratory system comorbidities (OR=2.020, 95% CI: 1.287 to 3.170, P=0.002),cardiovascular comorbidities (OR=1.388, 95% CI: 1.098 to 1.754, P=0.006), and neurological system comorbidities (OR=1.778, 95% CI: 1.346 to 2.349, P<0.001) were the risk factors for 30-day complications after surgery in elderly patients with hip fracture. Based on these risk factors, a nomogram was created, with an area under the curve of 0.714. The calibration graph showed that the incidence predicted was close to that measured.
ConclusionThe present study has established a visualized nomogram which can predict the rate of 30-day complications in the elderly patients after hip fracture based on age, time from injury to surgery, white blood cell count, serum albumin levels, troponin I, and cardiovascular, respiratory and neurological complications.
Key words:
Hip fractures; Fracture fixation, intramedullary; Arthroplasty, replacement, hip; Postoperative complications; Risk factors; Nomogram; Aged
Contributor Information
Sun Fengpo
Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Liu Xiangxue
Department of Anesthesiology, Beijing Daxing District People's Hospital, Beijing 102600, China
Zhang Ze
Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Zhang Tongyi
Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Ji Quan
Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Wen Liangyuan
Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
