Correlation between Charlson comorbidity index and surgical prognosis in elderly patients with femoral neck fractures: a retrospective study.

OBJECTIVE

Femoral neck fractures (FNF) are known to have significant morbidity and mortality rates. Multiple chronic conditions (MCC) are defined as the presence of two or more chronic diseases that greatly affect the quality of life in older adults. The aim of this study is to explore the impact of MCC and Charlson comorbidity index (CCI) on surgical outcomes in patients with FNF.

METHODS

Patients with FNF who underwent joint replacement surgery were selected for this study. Patients who had two or more diseases simultaneously were divided into two groups: the MCC group and the non-MCC (NMCC) group. The CCI was calculated to assess the severity of patients' comorbidities in the MCC group. Baseline data, surgical details, and prognosis-related indicators were analyzed and compared between the two patient groups. Spearman correlation analysis was performed to assess the relationship between CCI and length of hospital stay, Harris score, skeletal muscle index (SMI), and age. Univariate and multivariate logistic regression analysis was conducted to identify the risk factors for mortality in FNF patients at 1 and 5 years after surgery.

RESULTS

A total of 103 patients were included in the MCC group, while the NMCC group consisted of 40 patients. However, the patients in the MCC group were found to be older, had a higher incidence of sarcopenia, and lower SMI values (p < 0.001). Patients in the MCC group had longer hospitalization times, lower Harris scores, higher intensive care unit (ICU) admission rates, and higher complication rates (p = 0.045, p = 0.035, p = 0.019, p = 0.010). Spearman correlation analysis revealed that CCI was positively correlated with hospitalization and age (p < 0.001, p < 0.001), while it was negatively correlated with Harris score and SMI value (p < 0.001, p < 0.001). Univariate and multivariate logistic regression analysis demonstrated that MCC patients had higher 1-year and 5-year mortality rates. Hospitalization time was identified as a risk factor for death in FNF patients 1 year after joint replacement (p < 0.001), whereas CCI and age were identified as risk factors for death 5 years after surgery (p < 0.001, p < 0.001). Kaplan-Meier survival analysis results showed that the difference in death time between the two groups of patients with MCC and NMCC was statistically significant (p < 0.001). Cox proportional hazard model analysis showed that CCI, age and SMI were risk factors affecting patient death.

CONCLUSION

The surgical prognosis of patients with MCC, CCI and FNF is related. The higher the CCI, the worse the patient's function and the higher the long-term risk of death.