Prediction of postoperative mortality in elderly patient with hip fractures

a single-centre, retrospective cohort study

Romain Niessen (Corresponding Author), Benoit Bihin, Maximilien Gourdin, Jean Cyr Yombi, Olivier Cornu, Patrice Forget

Research output: Contribution to journalArticle

Abstract

© 2018 The Author(s). Background: Elderly patients are at high risk for postoperative complications and increased mortality after hip fracture (HF) surgery due to frailty and co-morbidities. The prediction of postoperative outcome could be used for clinical decision making. A reliable score to predict postoperative mortality after HF surgery in this sub-population remains unavailable. Methods: A single-centre retrospective cohort study was performed in 782 patients who were operated on for HF. Receiver Operating Characteristic (ROC)-curves were used to analyse the performance of gender, age, neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) at admission (D 0 ) as prognostic factors, alone or combined with the PreOperative Score to predict PostOperative Mortality (POSPOM) in univariate and multivariate linear regression models. Results: No correlation between gender, age, NLR D 0 or CRP D 0 and postoperative, intra-hospital mortality was found. The Area Under the ROC-curve (AUC) for age, male gender, NLR and CRP were 0.61 [95% confidence interval (CI) = 0.45-0.61], 0.56 [95% CI = 0.42-0.56], 0.47 [95% CI = 0.29-0.47] and 0.49 [95% CI = 0.31-0.49] respectively. Combination with the POSPOM score did not increase its discriminative capacity as neither age (AUC = 0.69, 95% CI = 0.54-0.69), gender (AUC = 0.72, 95% CI = 0.58-0.72), NLR D 0 (AUC = 0.71, 95% CI = 0.56-0.71), nor the CRP D 0 (AUC = 0.71, 95% CI = 0.58-0.71) improved the POSPOM performance. Conclusions: Neither age, gender, NLR D 0 nor CRP D 0 are suitable parameters to predict postoperative, intra-hospital mortality in elderly patients undergoing surgery for HF.
Original languageEnglish
Article number183
JournalAnesthesiology
Volume18
Issue number1
DOIs
Publication statusPublished - 3 Dec 2018

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Hip Fractures
Cohort Studies
Retrospective Studies
ROC Curve
Confidence Intervals
C-Reactive Protein
Mortality
Neutrophils
Area Under Curve
Lymphocytes
Hospital Mortality
Linear Models
Morbidity
Population

Keywords

  • Biomarkers
  • C-reactive protein
  • Frailty
  • Hip fractures
  • Hospital mortality

Cite this

Prediction of postoperative mortality in elderly patient with hip fractures : a single-centre, retrospective cohort study. / Niessen, Romain (Corresponding Author); Bihin, Benoit; Gourdin, Maximilien; Yombi, Jean Cyr; Cornu, Olivier; Forget, Patrice.

In: Anesthesiology, Vol. 18, No. 1, 183, 03.12.2018.

Research output: Contribution to journalArticle

Niessen, Romain ; Bihin, Benoit ; Gourdin, Maximilien ; Yombi, Jean Cyr ; Cornu, Olivier ; Forget, Patrice. / Prediction of postoperative mortality in elderly patient with hip fractures : a single-centre, retrospective cohort study. In: Anesthesiology. 2018 ; Vol. 18, No. 1.
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abstract = "{\circledC} 2018 The Author(s). Background: Elderly patients are at high risk for postoperative complications and increased mortality after hip fracture (HF) surgery due to frailty and co-morbidities. The prediction of postoperative outcome could be used for clinical decision making. A reliable score to predict postoperative mortality after HF surgery in this sub-population remains unavailable. Methods: A single-centre retrospective cohort study was performed in 782 patients who were operated on for HF. Receiver Operating Characteristic (ROC)-curves were used to analyse the performance of gender, age, neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) at admission (D 0 ) as prognostic factors, alone or combined with the PreOperative Score to predict PostOperative Mortality (POSPOM) in univariate and multivariate linear regression models. Results: No correlation between gender, age, NLR D 0 or CRP D 0 and postoperative, intra-hospital mortality was found. The Area Under the ROC-curve (AUC) for age, male gender, NLR and CRP were 0.61 [95{\%} confidence interval (CI) = 0.45-0.61], 0.56 [95{\%} CI = 0.42-0.56], 0.47 [95{\%} CI = 0.29-0.47] and 0.49 [95{\%} CI = 0.31-0.49] respectively. Combination with the POSPOM score did not increase its discriminative capacity as neither age (AUC = 0.69, 95{\%} CI = 0.54-0.69), gender (AUC = 0.72, 95{\%} CI = 0.58-0.72), NLR D 0 (AUC = 0.71, 95{\%} CI = 0.56-0.71), nor the CRP D 0 (AUC = 0.71, 95{\%} CI = 0.58-0.71) improved the POSPOM performance. Conclusions: Neither age, gender, NLR D 0 nor CRP D 0 are suitable parameters to predict postoperative, intra-hospital mortality in elderly patients undergoing surgery for HF.",
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T1 - Prediction of postoperative mortality in elderly patient with hip fractures

T2 - a single-centre, retrospective cohort study

AU - Niessen, Romain

AU - Bihin, Benoit

AU - Gourdin, Maximilien

AU - Yombi, Jean Cyr

AU - Cornu, Olivier

AU - Forget, Patrice

PY - 2018/12/3

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N2 - © 2018 The Author(s). Background: Elderly patients are at high risk for postoperative complications and increased mortality after hip fracture (HF) surgery due to frailty and co-morbidities. The prediction of postoperative outcome could be used for clinical decision making. A reliable score to predict postoperative mortality after HF surgery in this sub-population remains unavailable. Methods: A single-centre retrospective cohort study was performed in 782 patients who were operated on for HF. Receiver Operating Characteristic (ROC)-curves were used to analyse the performance of gender, age, neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) at admission (D 0 ) as prognostic factors, alone or combined with the PreOperative Score to predict PostOperative Mortality (POSPOM) in univariate and multivariate linear regression models. Results: No correlation between gender, age, NLR D 0 or CRP D 0 and postoperative, intra-hospital mortality was found. The Area Under the ROC-curve (AUC) for age, male gender, NLR and CRP were 0.61 [95% confidence interval (CI) = 0.45-0.61], 0.56 [95% CI = 0.42-0.56], 0.47 [95% CI = 0.29-0.47] and 0.49 [95% CI = 0.31-0.49] respectively. Combination with the POSPOM score did not increase its discriminative capacity as neither age (AUC = 0.69, 95% CI = 0.54-0.69), gender (AUC = 0.72, 95% CI = 0.58-0.72), NLR D 0 (AUC = 0.71, 95% CI = 0.56-0.71), nor the CRP D 0 (AUC = 0.71, 95% CI = 0.58-0.71) improved the POSPOM performance. Conclusions: Neither age, gender, NLR D 0 nor CRP D 0 are suitable parameters to predict postoperative, intra-hospital mortality in elderly patients undergoing surgery for HF.

AB - © 2018 The Author(s). Background: Elderly patients are at high risk for postoperative complications and increased mortality after hip fracture (HF) surgery due to frailty and co-morbidities. The prediction of postoperative outcome could be used for clinical decision making. A reliable score to predict postoperative mortality after HF surgery in this sub-population remains unavailable. Methods: A single-centre retrospective cohort study was performed in 782 patients who were operated on for HF. Receiver Operating Characteristic (ROC)-curves were used to analyse the performance of gender, age, neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) at admission (D 0 ) as prognostic factors, alone or combined with the PreOperative Score to predict PostOperative Mortality (POSPOM) in univariate and multivariate linear regression models. Results: No correlation between gender, age, NLR D 0 or CRP D 0 and postoperative, intra-hospital mortality was found. The Area Under the ROC-curve (AUC) for age, male gender, NLR and CRP were 0.61 [95% confidence interval (CI) = 0.45-0.61], 0.56 [95% CI = 0.42-0.56], 0.47 [95% CI = 0.29-0.47] and 0.49 [95% CI = 0.31-0.49] respectively. Combination with the POSPOM score did not increase its discriminative capacity as neither age (AUC = 0.69, 95% CI = 0.54-0.69), gender (AUC = 0.72, 95% CI = 0.58-0.72), NLR D 0 (AUC = 0.71, 95% CI = 0.56-0.71), nor the CRP D 0 (AUC = 0.71, 95% CI = 0.58-0.71) improved the POSPOM performance. Conclusions: Neither age, gender, NLR D 0 nor CRP D 0 are suitable parameters to predict postoperative, intra-hospital mortality in elderly patients undergoing surgery for HF.

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