Lu Xingchen, Wang Ziming, Chong Feifei, Wang Yu, Wu Siyu, Du Quanyin, Gou Wenlong, Peng Keyun, Xiong Yan
Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Front Surg. 2022 Jun 28;9:926745. doi: 10.3389/fsurg.2022.926745. eCollection 2022.
China has become an ageing society and as it continues to age, it will face an increasing number of hip fractures in nonagenarians. However, few preoperative assessment tools to determine the postoperative mortality risk in nonagenarians with hip fracture were available. The aim of this study was to identify all-cause mortality risk factors after hip arthroplasty in nonagenarians with hip fractures and to establish a new nomogram model to optimize the individualized hip arthroplasty in nonagenarians with hip fractures.
We retrospectively studied 246 consecutive nonagenarians diagnosed with hip fracture from August 2002 to February 2021 at our center. During the follow-up, 203 nonagenarians with a median age of 91.9 years treated with hip arthroplasty were included, of which 136 were females and 67 were males, and 43 nonagenarians were excluded (40 underwent internal fixation and 3 were lost to follow-up). The full cohort was randomly divided into training (50%) and validation (50%) sets. The potential predictive factors for 1-year all-cause mortality after hip arthroplasty were assessed by univariate and multivariate COX proportional hazards regression on the training set, and then, a new nomogram model was established and evaluated by concordance index (C-index) and calibration curves.
After analyzing 44 perioperative variables including demographic characteristics, vital signs, surgical data, laboratory tests, we identified that age-adjusted Charlson Comorbidity Index (aCCI) (= 0.042), American Society of Anesthesiologists (ASA) classification (= 0.007), Urea (= 0.028), serum Ca (= 0.011), postoperative hemoglobin (= 0.024) were significant predictors for 1-year all-cause mortality after hip arthroplasty in the training set. The nomogram showed a robust discrimination, with a C-index of 0.71 (95%CIs, 0.68-0.78). The calibration curves for 1-year all-cause mortality showed optimal agreement between the probability as predicted by the nomogram and the actual probability in training and validation sets.
A novel nomogram model integrating 5 independent predictive variables were established and validated. It can effectively predict 1-year all-cause mortality after hip arthroplasty in nonagenarians with hip fracture and lead to a more optimized and rational therapeutic choice.
中国已步入老龄化社会，且老龄化程度持续加深，百岁老人髋部骨折的数量将不断增加。然而，目前几乎没有术前评估工具可用于确定百岁老人髋部骨折术后的死亡风险。本研究旨在确定百岁老人髋部骨折行髋关节置换术后全因死亡的危险因素，并建立一种新的列线图模型，以优化百岁老人髋部骨折的个体化髋关节置换术。
我们回顾性研究了2002年8月至2021年2月在本中心连续诊断为髋部骨折的246例百岁老人。在随访期间，纳入了203例行髋关节置换术的百岁老人，中位年龄为91.9岁，其中女性136例，男性67例，排除43例百岁老人（40例行内固定术，3例失访）。将整个队列随机分为训练集（50%）和验证集（50%）。通过单因素和多因素COX比例风险回归分析训练集，评估髋关节置换术后1年全因死亡的潜在预测因素，然后建立新的列线图模型，并通过一致性指数（C指数）和校准曲线进行评估。
在分析了包括人口统计学特征、生命体征、手术数据、实验室检查等44个围手术期变量后，我们确定年龄校正的Charlson合并症指数（aCCI）（=0.042）、美国麻醉医师协会（ASA）分级（=0.007）、尿素（=0.028）、血清钙（=0.011）、术后血红蛋白（=0.024）是训练集中髋关节置换术后1年全因死亡的显著预测因素。列线图显示出较强的区分能力，C指数为0.71（95%置信区间，0.68 - 0.78）。1年全因死亡的校准曲线显示，列线图预测的概率与训练集和验证集中的实际概率之间具有最佳一致性。
建立并验证了一个整合5个独立预测变量的新型列线图模型。它可以有效预测百岁老人髋部骨折行髋关节置换术后1年的全因死亡，并有助于做出更优化、更合理的治疗选择。
