Department of Orthopedics Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.
School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):4157-4167. doi: 10.1007/s00068-022-01960-9. Epub 2022 Mar 30.
Among hip fracture patients both dementia and frailty are particularly prevalent. The aim of the current study was to determine if dementia functions as a surrogate for frailty, or if it confers additional information as a comorbidity when predicting postoperative mortality after a hip fracture.
All adult patients who suffered a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017 were considered for inclusion. Pathological fractures, non-operatively treated fractures, reoperations, and patients missing data were excluded. Logistic regression (LR) models were fitted, one including and one excluding measurements of frailty, with postoperative mortality as the response variable. The primary outcome of interest was 30-day postoperative mortality. The relative importance for all variables was determined using the permutation importance. New LR models were constructed using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models.
121,305 patients were included in the study. Initially, dementia was among the top ten most important variables for predicting 30-day mortality. When measurements of frailty were included, dementia was replaced in relative importance by the ability to walk alone outdoors and institutionalization. There was no significant difference in the predictive ability of the models fitted using the top ten most important variables when comparing those that included [AUC for 30-day mortality (95% CI): 0.82 (0.81-0.82)] and excluded [AUC for 30-day mortality (95% CI): 0.81 (0.80-0.81)] measurements of frailty.
Dementia functions as a surrogate for frailty when predicting mortality up to one year after hip fracture surgery. The presence of dementia in a patient without frailty does not appreciably contribute to the prediction of postoperative mortality.
在髋部骨折患者中，痴呆症和衰弱症都特别普遍。本研究的目的是确定痴呆症是否可以作为衰弱症的替代指标，或者在预测髋部骨折术后死亡率时，作为合并症是否提供额外信息。
所有 2008 年 1 月 1 日至 2017 年 12 月 31 日期间在瑞典因创伤性髋部骨折而接受治疗的成年患者均被考虑纳入研究。排除病理性骨折、非手术治疗的骨折、再次手术以及数据缺失的患者。使用逻辑回归（LR）模型拟合，一个模型包含衰弱症的测量结果，另一个模型不包含，术后死亡率作为反应变量。主要研究结果为 30 天术后死亡率。使用置换重要性确定所有变量的相对重要性。使用排名前十的最重要变量构建新的 LR 模型。使用接收者操作特征曲线（ROC）下面积（AUC）比较这些模型的预测能力。
本研究共纳入 121305 名患者。最初，痴呆症是预测 30 天死亡率的前 10 个最重要变量之一。当包含衰弱症的测量结果时，痴呆症在相对重要性方面被独立于户外行走能力和机构化取代。使用排名前十的最重要变量拟合的模型在预测能力方面没有显著差异，包括[30 天死亡率的 AUC（95%CI）：0.82（0.81-0.82）]和排除[30 天死亡率的 AUC（95%CI）：0.81（0.80-0.81）]的衰弱症测量结果。
在预测髋部骨折手术后 1 年内的死亡率时，痴呆症可以作为衰弱症的替代指标。在没有衰弱症的患者中出现痴呆症，并不会显著增加对术后死亡率的预测能力。
