[Risk factors of postoperative complications in elderly patients with fragile hip fractures and their influence on...

To analyze the risk factors for postoperative complications in elderly patients with fragile hip fractures and their impact on postoperative mobility, and to construct a risk prediction model.

A retrospective analysis was performed on the postoperative clinical data of 278 elderly patients diagnosed with fragility hip fractures, who received treatment between January 2019 and December 2024. Of these patients, 120 were male and 158 were female, aged from 63 to 82 with a mean age of (74.91±4.87) years old and an average bone mineral density (BMD) T uale was raging from -3.63 to -2.15 with an aberage of (-2.89±0.74) g·cm^-2. The patients were categorized into two groups based on the presence or absence of postoperative complications:the complication group(78 patients) and the non-complication group (200 patients). Furthermore, according to the postoperative functional mobility status of elderly patients with fragile hip fractures, those in the complication group were further classified into a good activity ability group(37 patients) and a limited activity ability group (41patients). Clinical data were collected from patients, including gender, Charlson comorbidity index (CCI), mini-mental state examination(MMSE) scores, age, type of surgical procedure, and time to ambulation. The study further analyzed potential risk factors for postoperative complications and their impact on patients' postoperative functional mobility.

There were statistically significant differences between the complication group and the non-complication group with respect to age, MMSE score, CCI score, type of surgery, operation time, intraoperative blood loss, anesthesia method, and preoperative nutritional status(P<0.05). Logistic regression analysis demonstrated that age[OR=1.167, 95% CI(1.103, 1.234), P=0.001], MMSE score [OR=0.847, 95% CI(0.775, 0.927), P=0.001], CCI score[OR=1.374, 95% CI(1.099, 1.718), P=0.005], type of surgery [OR=2.976, 95% CI(1.700, 5.208), P=0.001], operation time [OR=2.065, 95% CI(1.209, 3.528), P=0.008], intraoperative blood loss[OR=1.024, 95% CI(1.004, 1.044), P=0.020], anesthesia method [OR=2.165, 95% CI(1.267, 3.698), P=0.005], and preoperative nutritional status[OR=0.500, 95% CI(0.348, 0.719), P=0.001], were significant independent risk factors associated with the development of postoperative complications in elderly patients with brittle hip fractures. There were statistically significant differences in activity levels among patients with different types of complications (P<0.05). Additionally, statistically significant differences were observed in the incidence of complications including pulmonary infection, deep vein thrombosis, pressure ulcers, surgical site infection, and cardiovascular and cerebrovascular diseases between the group with good activity ability and the group with limited activity ability (P<0.05). The receiver operating characteristic(ROC) curve of the nomogram prediction model, constructed based on independent risk factors, demonstrates that the mean area under the curve (AUC)>0.800 for each influencing factor.

The risk prediction model developed through multifactorial analysis facilitates the early identification of postoperative complications and functional limitations in elderly patients with fragility hip fractures, thereby supporting the clinical formulation of individualized intervention strategies and improving patient outcomes.