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Patient survival and surgical re-intervention predictors for intracapsular hip fractures
David González Quevedo1, Iskandar Tamimi Mariño1, Juan Manuel Sánchez Siles1
1Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Spain.
Insights
Predicting survival after hip fracture surgery is crucial. The age-adjusted Charlson Comorbidity Index (ACCI) and American Society of Anesthesiologists (ASA) score effectively predict 2-year mortality in elderly patients undergoing hip replacement.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Anesthesiology
Background:
- Intracapsular hip fractures in elderly patients present a challenge for treatment selection between total hip replacement (THR) and partial hip replacement (PHR).
- Objective prediction of patient survival and re-intervention risk is vital for optimal implant choice.
Purpose of the Study:
- To evaluate the predictive value of the age-adjusted Charlson Comorbidity Index (ACCI) and the American Society of Anesthesiologists (ASA) score for 2-year mortality and surgical re-intervention in elderly patients with intracapsular hip fractures.
Main Methods:
- A retrospective cohort study included 356 patients over 70 years old treated for intracapsular hip fractures between 2010 and 2013.
- ACCI and ASA scores were calculated, and patients were followed for 2 years post-surgery.
- Multivariate Cox proportional hazard models were used to compare survival and re-intervention rates between groups.
Main Results:
- Higher ACCI (ACCI >7) and ASA (ASA >3) scores were significantly associated with increased 2-year all-cause mortality (aHR 3.2 and 3.12, respectively).
- An ASA score >3 showed a quasi-significant increase in re-intervention risk (aHR 2.2).
- ACCI demonstrated higher specificity (91.1%) and negative predictive value (74.4%) for mortality prediction, while ASA had higher sensitivity (49.6%).
Conclusions:
- Both ACCI and ASA scores are valuable tools for predicting 2-year survival in patients with intracapsular hip fractures.
- The ASA score additionally aids in predicting the risk of surgical re-intervention for this patient population.
Background:
Choosing between total hip replacement (THR) and partial hip replacement (PHR) for patients with intracapsular hip fractures is often based on subjective factors. Predicting the survival of these patients and risk of surgical re-intervention is essential to select the most adequate implant.
Methods:
We conducted a retrospective cohort study on mortality of patients over 70 years with intracapsular hip fractures who were treated between January 2010 and December 2013, with either PHR or THR. Patients' information was withdrawn from our local computerized database. The age-adjusted Charlson comorbidity index (ACCI) and American Society of Anesthesiologists (ASA) score were calculated for all patients. The patients were followed for 2 years after surgery. Survival and surgical re-intervention rates were compared between the two groups using a Multivariate Cox proportional hazard model.
Results:
A total of 356 individuals were included in this study. At 2 years of follow-up, 221 (74.4%) of the patients with ACCI score≤7 were still alive, in contrast to only 20 (29.0%) of those with ACCI score>7. In addition, 201 (76.2%) of the patients with ASA score≤3 were still alive after 2 years, compared to 30 (32.6%) of individuals with ASA >3. Patients with the ACCI score>7, and ASA score>3 had a significant increase in all-cause 2-year mortality (adjusted hazard ratio of 3.2, 95% CI 2.2-4.6; and 3.12, 95% CI 2.2-4.5, respectively). Patients with an ASA score>3 had a quasi-significant increase in the re-intervention risk (adjusted hazard ratio 2.2, 95% CI 1.0-5.1). The sensitivity, specificity, positive predictive value and negative predictive values of ACCI in predicting 2-year mortality were 39.2%, 91.1%, 71%, and 74.4%, respectively. On the other hand, the sensitivity, specificity, positive predictive value and negative predictive values of ASA score in predicting 2-year mortality were 49.6%, 79.1%, 67.4%, and 76.1%, respectively.
Conclusions:
Both ACCI and ASA scales were able to predict the 2-year survival of patients with intracapsular hip fractures. The ASA scale was also able to predict the risk of re-intervention in these patients.
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