Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
Osteoporosis Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
Sci Rep. 2023 Jul 8;13(1):11091. doi: 10.1038/s41598-023-38297-1.
Despite the abundance of research on the risk factors for mortality following hip fracture surgery, there has been a dearth of studies on prediction models in this population. The objective of this research was to explore the influencing factors and construct a clinical nomogram to predict one-year postoperative mortality in patients with hip fracture surgeries. Using the Ditmanson Research Database (DRD), we included 2333 subjects, aged ≥ 50 years who underwent hip fracture surgery between October, 2008 and August, 2021. The endpoint was all-cause mortality. A least absolute shrinkage and selection operator (LASSO) derived Cox regression was performed to select the independent predictors of one-year postoperative mortality. A nomogram was built for predicting one-year postoperative mortality. The prognostic performance of nomogram was evaluated. On the basis of tertiary points in a nomogram, the patients were divided into low, middle and high risk groups, and compared by the Kaplan-Meier analysis. Within 1 year after hip fracture surgery, 274 patients (11.74%) died. Variables retained in the final model comprised age, sex, length of stay, RBC transfusions, hemoglobin, platelet, and eGFR. The AUC for one-year mortality predictions were 0.717 (95% CI = 0.685-0.749). The Kaplan-Meier curves were significantly different among the three risk groups (p < 0.001). The nomogram showed good calibration. In summary, we explored the one-year postoperative mortality risk in geriatric patients with a hip fracture and developed a prediction model that could help clinicians identify patients at high risk of postoperative mortality.
尽管有大量研究探讨了髋部骨折手术后死亡的风险因素,但针对该人群的预测模型研究却很少。本研究旨在探讨影响因素,并构建一个临床列线图来预测髋部骨折手术后患者的一年术后死亡率。我们使用迪特曼斯研究数据库(DRD)纳入了 2333 名年龄≥50 岁、2008 年 10 月至 2021 年 8 月期间接受髋部骨折手术的患者。终点是全因死亡率。使用最小绝对收缩和选择算子(LASSO)推导的 Cox 回归分析来选择一年术后死亡率的独立预测因素。构建了一个预测一年术后死亡率的列线图。评估了列线图的预测性能。根据列线图中的三个三分位数,将患者分为低、中、高危组,并进行 Kaplan-Meier 分析比较。在髋部骨折手术后 1 年内,有 274 名患者(11.74%)死亡。最终模型中保留的变量包括年龄、性别、住院时间、RBC 输血、血红蛋白、血小板和 eGFR。一年死亡率预测的 AUC 为 0.717(95%CI=0.685-0.749)。Kaplan-Meier 曲线在三组之间有显著差异(p<0.001)。列线图显示出良好的校准。总之,我们探讨了老年髋部骨折患者一年术后死亡率的风险,并开发了一个预测模型,有助于临床医生识别术后死亡率高的患者。