Ferro Flávio Cruz, Campos Marcos Adriano Garcia, Picolli Thais Caroline Silva, de Sá Mayoral Vania, Soares Victoria Moralez, Ferreira Jessica Caroline, Peres Lucas Dias Borges, Tibeau Theodor Terra Mayer, Bernardi Victor El Chihimi, Pereira David Nascimento, Gumieiro David Nicoletti, Curcelli Emilio Carlos, Navarro E Lima Lais Helena, do Nascimento Junior Paulo, Lazzarin Taline, Ballarin Raquel Simões, Okoshi Marina Politi, Minicucci Marcos Ferreira, de Paiva Sergio Alberto Rupp, Gordon Adam Lee, Sahota Opinder, Pereira Filipe Welson Leal, Azevedo Paula Schmidt
Internal Medicine Department, Medical School, São Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, Botucatu, SP, 18618-970, Brazil.
Global Emergency Medicine Innovation and Implementation Research Center, Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA.
Sci Rep. 2025 Feb 15;15(1):5607. doi: 10.1038/s41598-025-89869-2.
Perioperative risk assessment helps inform clinical practice for older people with hip fractures. This is a cohort study, where perioperative risk screening, including NHFS, was performed at admission, followed by an evaluation of 30-day outcomes. 503 patients were included, 73% female, 79.4 ± 9.3 years old; 58% presented extracapsular and 42% intracapsular fractures, with a 30-day mortality of 9%. The NHFS was higher in the patients who died at 5.6 ± 1.1 compared to survivals at 4.3 ± 1.5 (p-value < 0.001). NHFS > 4 was associated with 30-day mortality observed by Cox regression adjusted by fracture type: HR 4.55 (95% CI 2.10-9.82) (p-value < 0.001) and Kaplan-Meyer Curve (HR 3.94; 95% CI 2.19-7.07; p-value < 0.001). ROC curve showed the accuracy of NHFS in explaining 30-day mortality (AUC 0.74; 95% CI 0.67-0.81). Complications were higher among patients with NHFS > 4. The performance of NHFS was better than the traditional perioperative risk ASA score. Therefore, NHFS can be implemented in real-world clinical practice to estimate the 30-day mortality risk for hip fracture in older patients in Brazil. NHFS > 4 is critical for 30-day mortality and complications; this cutoff helps inform clinical practice. The present study might motivate other centers to consider NHFS in their perioperative risk assessment routine.
围手术期风险评估有助于为老年髋部骨折患者的临床实践提供参考。这是一项队列研究，在入院时进行围手术期风险筛查，包括NHFS，随后评估30天的结局。纳入了503例患者，73%为女性，年龄79.4±9.3岁；58%为囊外骨折，42%为囊内骨折，30天死亡率为9%。死亡患者的NHFS为5.6±1.1，高于存活患者的4.3±1.5（p值<0.001）。通过骨折类型调整的Cox回归观察到，NHFS>4与30天死亡率相关：HR 4.55（95%CI 2.10-9.82）（p值<0.001）以及Kaplan-Meier曲线（HR 3.94；95%CI 2.19-7.07；p值<0.001）。ROC曲线显示NHFS在解释30天死亡率方面的准确性（AUC 0.74；95%CI 0.67-0.81）。NHFS>4的患者并发症更多。NHFS的表现优于传统的围手术期风险ASA评分。因此，NHFS可在巴西的实际临床实践中用于估计老年髋部骨折患者30天的死亡风险。NHFS>4对30天死亡率和并发症至关重要；这一临界值有助于指导临床实践。本研究可能会促使其他中心在其围手术期风险评估常规中考虑NHFS。
