Huang Nicole, Cheng Teresa, Joyce Cara, Cohen Joseph, Levack Ashley E
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S First Ave, Maywood, IL, 60153, USA.
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
Arch Orthop Trauma Surg. 2024 Dec 21;145(1):77. doi: 10.1007/s00402-024-05666-y.
To measure the predictive value of three perioperative risk assessment tools (National Surgical Quality Improvement Program-NSQIP, Modified 5-factor Frailty Index-mFI-5, and Score for Trauma Triage in Geriatric and Middle Aged-STTGMA) in predicting postoperative complications in older adult ankle fractures.
This is a retrospective study of surgically treated isolated older adult ankle fractures at an academic center between 2007 and 2022. Exclusion criteria included age < 55 years, presence of pathologic fractures, and having multiple orthopaedic injuries. Patient sociodemographic information, injury characteristics, clinical outcomes, and complications were obtained. Data was entered into the NSQIP, mFI-5, and STTGMA calculators. Descriptive statistics and univariable logistic regression models were calculated for each outcome of interest. Area under the receiver operative curves (AUC) were determined as a measure of tool discrimination.
382 patients met inclusion criteria. The average age was 67 years, 33% were male, and 87% ambulated without assistive devices prior to injury. 23.6% of all patients had a complication: 12.8% had at least one minor complication, 15.7% had at least one major complication, and 2.4% had surgical complications. Mortality within 1 year of initial injury was 2.9%. NSQIP was the best predictor of any complication (AUC 0.74) compared to the mFI-5 (AUC 0.68), and STTGMA (AUC 0.72).
NSQIP performed better than mFI-5, STTGMA, and CCI for postoperative complications and mortality, but none of the perioperative risk assessment tools performed exceptionally well in the context of isolated older adult ankle fractures.
评估三种围手术期风险评估工具（美国国立外科手术质量改进计划-NSQIP、改良5因素衰弱指数-mFI-5和老年及中年创伤分诊评分-STTGMA）对老年成人踝关节骨折术后并发症的预测价值。
这是一项对2007年至2022年在某学术中心接受手术治疗的孤立性老年成人踝关节骨折的回顾性研究。排除标准包括年龄<55岁、病理性骨折以及存在多处骨科损伤。获取患者的社会人口统计学信息、损伤特征、临床结局和并发症。将数据输入NSQIP、mFI-5和STTGMA计算器。对每个感兴趣的结局计算描述性统计量和单变量逻辑回归模型。确定受试者工作曲线下面积（AUC）作为工具区分度的指标。
382例患者符合纳入标准。平均年龄为67岁，33%为男性，87%在受伤前无需辅助器械即可行走。所有患者中有23.6%发生了并发症：12.8%至少发生了一种轻微并发症，15.7%至少发生了一种严重并发症，2.4%发生了手术并发症。初次受伤后1年内的死亡率为2.9%。与mFI-5（AUC 0.68）和STTGMA（AUC 0.72）相比，NSQIP是任何并发症的最佳预测指标（AUC 0.74）。
在预测术后并发症和死亡率方面，NSQIP比mFI-5、STTGMA和CCI表现更好，但在孤立性老年成人踝关节骨折的情况下，没有一种围手术期风险评估工具表现得特别出色。
