Development and Validation of Daping Orthopedics Operative Risk Scoring System for Geriatric Hip Fracture (DOORS-GHF)...

With China's accelerating population aging, geriatric hip fractures pose a growing clinical challenge. High comorbidity burden and diminished physiological reserve drive elevated postoperative complication and mortality risks in this population. However, most existing systems were developed decades ago, incompatible with modern perioperative advances, and are not tailored for geriatric hip fracture patients, resulting in unsatisfactory predictive specificity. To fill this gap, we developed the Daping Orthopedics Operative Risk Scoring System for Geriatric Hip Fracture (DOORS-GHF) and evaluated its predictive accuracy and clinical utility.

We collected 4417 geriatric patients with hip fractures who underwent operative treatment at multicenter hospitals between 2012 and 2025. A total of 1599 patients were finally enrolled in this study. Of these, 1199 cases were included for the development of the scoring system. Using binary logistic regression with preoperative physiological score (PS) and operative severity score (OS) as independent variables, we constructed the DOORS-GHF model to predict 30-day postoperative complications and mortality. The remaining 400 cases formed the external validation cohort, in which we compared DOORS-GHF against the Daping Orthopedic Operative Risk Scoring System for Senile Patient version 3.0 (DORSSSP v3.0) and the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) using AUC, sensitivity, specificity, Hosmer-Lemeshow calibration, Brier score, and decision curve analysis (DCA).

The DOORS-GHF predictive equations were ln[R/(1 - R)] = -5.089 - 0.114 × OS + 0.226 × PS (complications) and ln[Z/(1 - Z)] = -10.308 + 0.655 × OS + 0.201 × PS (mortality). In the validation cohort (n = 400), 30-day mortality was 2.0% (8/400) and complication rate was 6.5% (26/400). DOORS-GHF outperformed both comparators across all metrics. For complication prediction, it achieved the highest AUC (0.878), acceptable calibration (HL χ² = 11.887, p = 0.156), and the lowest Brier score (0.0489). For mortality prediction, it achieved the highest AUC (0.968), good calibration (HL χ² = 6.259, p = 0.510), and the lowest Brier score (0.0140). DCA confirmed the broadest clinical net benefit for DOORS-GHF across threshold ranges of 0-0.65 (complications) and 0-0.40 (mortality).

DOORS-GHF demonstrated superior discrimination, calibration, accuracy, and clinical utility over DORSSSP v3.0 and P-POSSUM in geriatric hip fracture patients. As a precise and practical system for assessing the risk of 30-day postoperative complications and mortality, it holds strong potential to improve perioperative decision-making and patient counseling in this vulnerable population.