Predicting 90-Day Mortality After Geriatric Hip Fracture Using Combined Preoperative and Perioperative Risk Factors.

Area of Science:

• Geriatric Medicine
• Orthopedic Surgery
• Clinical Epidemiology

Background:

• Hip fractures in the elderly are linked to high 90-day mortality rates.
• Existing predictive models often overlook critical perioperative factors.
• This study addresses the need for comprehensive risk assessment in this vulnerable population.

Purpose of the Study:

• To develop and validate two risk score models for predicting 90-day mortality after hip fracture surgery.
• To integrate both preoperative and perioperative variables for enhanced predictive accuracy.
• To provide a practical tool for risk stratification at various clinical decision points.

Main Methods:

• Retrospective review of medical records for patients aged ≥65 years undergoing hip fracture surgery.
• Evaluation of five preoperative risk factors: Prognostic Nutritional Index <40, age ≥85, ≥4 comorbidities, surgical delay >5 days, and intracapsular fracture.
• Development of two models: a five-factor preoperative score and a six-factor combined score including ICU stay ≥5 days. Performance assessed using logistic regression and ROC analysis.

Main Results:

• The 90-day mortality rate was 15.5% in the cohort of 387 patients.
• The preoperative five-factor score achieved an AUC of 0.722; the combined six-factor score achieved an AUC of 0.737.
• Each unit score increase elevated mortality odds approximately 2.68-fold, with mortality exceeding 50% for scores ≥4. Both models showed adequate calibration.

Conclusions:

• A two-stage scoring approach integrating admission-available and postoperative variables effectively predicts 90-day mortality in elderly hip fracture patients.
• The developed risk scores demonstrate acceptable discrimination and calibration.
• These models serve as practical tools for risk stratification in clinical decision-making for elderly hip fracture patients.