Bujakovic Tarik, Delibegovic Samir
University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.
Eur J Orthop Surg Traumatol. 2025 May 14;35(1):193. doi: 10.1007/s00590-025-04302-8.
A large number of patients with hip fractures develop postoperative complications. The APACHE II score has been shown its usefulness in surgical patients. We undertook a study to establish the ability of the APACHE score to assess the prediction of postoperative complications in patients over 65 years old with hip fractures, and to compare them with specific scoring systems developed for orthopaedic patients, and the general ASA Score and the Charlson Comorbidity Index (CCI).
In order to test the score, we used a prospective, cohort study in a tertiary care hospital with 410 consecutive patients aged ≥65 years old with hip fractures. The ASA score, CCI, the Nottingham Hip Fracture Score (NHFS), the POSSUM-P and the Acute Physiology and Chronic Health Evaluation (APACHE) II scores were tested. All complications up to 6 months post-operatively were registered. We categorized the complications according to the Clavien-Dindo score as minor (1-2) or major (3-5), and we analysed the major post-operative complications.
The sensitivity and specificity of APACHE score and the P-POSSUM scores were 53.2 and 90.0, and 73.8 and 72.9, respectively. The area beneath the ROC curve was better for P-POSSUM than for APACHE II, but the difference was not statistically significant. Both the P-POSSUM and APACHE II scores were statistically significantly better than ASA, the Nottingham score, and CCI.
This study showed that APACHE II and POSSUM-P can be used to predict postoperative complications in elderly people with hip fractures.
大量髋部骨折患者术后会出现并发症。急性生理与慢性健康状况评分系统Ⅱ（APACHE II）已被证明在外科患者中有用。我们开展了一项研究，以确定APACHE评分评估65岁以上髋部骨折患者术后并发症预测的能力，并将其与为骨科患者开发的特定评分系统、一般的美国麻醉医师协会（ASA）评分和查尔森合并症指数（CCI）进行比较。
为了测试该评分，我们在一家三级护理医院进行了一项前瞻性队列研究，纳入了410例年龄≥65岁的连续髋部骨折患者。测试了ASA评分、CCI、诺丁汉髋部骨折评分（NHFS）、简化手术应激评分系统（POSSUM-P）和急性生理与慢性健康状况评分系统（APACHE）Ⅱ评分。记录术后6个月内的所有并发症。我们根据Clavien-Dindo评分将并发症分为轻微（1-2级）或严重（3-5级），并分析主要的术后并发症。
APACHE评分和POSSUM-P评分的敏感性和特异性分别为53.2和90.0，以及73.8和72.9。简化手术应激评分系统（P-POSSUM）的受试者工作特征曲线下面积比APACHE II更好，但差异无统计学意义。P-POSSUM和APACHE II评分在统计学上均显著优于ASA、诺丁汉评分和CCI。
本研究表明，APACHE II和POSSUM-P可用于预测老年髋部骨折患者的术后并发症。
