Dwyer Jennifer G, Reynoso Jason F, Seevers Georgia A, Schmid Kendra K, Muralidhar Padmashri, Konigsberg Beau, Lynch Thomas G, Johanning Jason M
University of Nebraska Medical Center, Department of Surgery, Omaha, NE, USA.
NWI VA Medical Center, Department of Surgery, Omaha, NE, USA.
Geriatr Orthop Surg Rehabil. 2014 Sep;5(3):109-15. doi: 10.1177/2151458514537272.
End-of-life surgical care is a major concern with a significant number of operations performed within the last year of life; surgery for hip fractures is a prime example. Unfortunately, no simple objective tool exists to assess life expectancy in the postoperative period. The goal of our study was to analyze 2 simple geriatric life expectancy calculators to compare with the current Veterans Affairs Surgical Quality Improvement Program (VASQIP) postoperative 30-day mortality calculator.
This retrospective study assessed the utility of 3 validated calculators in 47 hip fracture repairs from July 2009 to May 2011. The tools included: 30-day VASQIP mortality calculator, 6-month Minimum Data Set Mortality Risk Index-Revised (MMRI-R), and Four-Year Mortality Index. The VASQIP calculator requires chart review, Current Procedural Terminology (CPT) codes, and laboratory analysis, whereas the mortality risk indices require simple patient questioning if prospective or simple chart review if retrospective. Scoring was performed and mortality risk was compared between survivors and nonsurvivors.
A total of 47 hip fractures were repaired during the study period with 37 survivors and 10 nonsurvivors. In all, 7 died within 30 days, 2 died within 6 months, and 1 died greater than 6 months after surgery. The mean age (standard deviation [SD]) of all patients undergoing hip fracture repair was 73.6 (13.3) years. The VASQIP calculator mean (SD) 30-day mortality risk was 10.4% (5.4) for nonsurvivors compared to survivors 4.3% (5.5), P < .003; the MMRI-R mean (SD) mortality risk was 35.8% (15.4) for nonsurvivors compared to survivors 14.7% (9.5), P < .001; the Four-Year Mortality Index mean (SD) mortality risk was 60.9% (16.9) for nonsurvivors compared to survivors 48.9% (24.4), P < .09.
Overall, the VASQIP 30-day and MMRI-R 6-month mortality calculators showed significant differences in mortality risk between survivors versus nonsurvivors in a population with hip fracture. In contrast, the Four-Year Mortality calculator may not sufficiently discriminate operative risk. The easily obtained MMRI-R has the potential to provide information on short-term postoperative mortality risk.
临终手术护理是一个主要关注点，在生命的最后一年会进行大量手术；髋部骨折手术就是一个典型例子。不幸的是，不存在简单的客观工具来评估术后预期寿命。我们研究的目的是分析两种简单的老年预期寿命计算器，并与当前退伍军人事务部手术质量改进计划（VASQIP）术后30天死亡率计算器进行比较。
这项回顾性研究评估了2009年7月至2011年5月期间47例髋部骨折修复手术中3种经过验证的计算器的效用。这些工具包括：30天VASQIP死亡率计算器、6个月最小数据集死亡率风险指数修订版（MMRI-R）和四年死亡率指数。VASQIP计算器需要查阅病历、现行手术操作术语（CPT）编码和实验室分析，而死亡率风险指数如果是前瞻性的则需要简单询问患者，如果是回顾性的则需要简单查阅病历。进行了评分，并比较了幸存者和非幸存者之间的死亡风险。
在研究期间共修复了47例髋部骨折，其中37例存活，10例死亡。总共7例在30天内死亡，2例在6个月内死亡，1例在术后6个月以上死亡。所有接受髋部骨折修复手术的患者的平均年龄（标准差[SD]）为73.6（13.3）岁。对于非幸存者，VASQIP计算器的平均（SD）30天死亡风险为10.4%（5.4），而幸存者为4.3%（5.5），P <.003；对于非幸存者，MMRI-R的平均（SD）死亡风险为35.8%（15.4），而幸存者为14.7%（9.5），P <.001；对于非幸存者，四年死亡率指数的平均（SD）死亡风险为60.9%（16.9），而幸存者为48.9%（24.4），P <.09。
总体而言，VASQIP 30天和MMRI-R 6个月死亡率计算器在髋部骨折患者群体中显示出幸存者与非幸存者之间死亡风险的显著差异。相比之下，四年死亡率计算器可能无法充分区分手术风险。易于获得的MMRI-R有可能提供有关术后短期死亡风险的信息。
