Lu Qiyuan, Chen Mengmeng, Ling Houfu
Department of Orthopaedics, Yuyao Hospital of Traditional Chinese Medicine, Ningbo, Zhengjiang, China.
Department of Orthopaedics, Cixi Third People's Hospital, Ningbo, Zhengjiang, China.
Front Surg. 2025 Jun 23;12:1415680. doi: 10.3389/fsurg.2025.1415680. eCollection 2025.
This study systematically evaluates the predictive capacity of seven risk stratification models for 12-month postoperative mortality in geriatric patients with fragility hip fractures, while concurrently assessing their risk classification accuracy to inform perioperative protocol formulation, rehabilitation strategies, and prognostic management.
Current clinical practice lacks standardized criteria for mortality risk prediction in elderly fragility hip fracture patients. This investigation conducts a comparative evaluation of seven prognostic models-the Sernbo Score, Jiang et al. model, Nottingham Hip Fracture Score (HFS), Holt et al. algorithm, HEMA, ASAgeCoGeCC Score, and SHiPS-HiPSe, and SHire, and SHim, HEMA, ham Hip Fracture Score (mortality risk prediction in elderly fragility hip fracture patients.
In this retrospective cohort analysis, all consecutive patients aged isk prediction in elderly fragility hip fracture between January 2018 and October 2022 were enrolled. Model-derived mortality predictions and risk categorizations were computed. Predictive performance was quantified through the predictive validity, the area under the receiver operating characteristic (ROC) curve (AUC) analysis, DeLong test, Hosmer-Lemeshow goodness-of-fit testing and calibration slope (95% CI), followed by precision assessment of risk stratification tiers.
The cohort demonstrated a 12-month mortality rate of 29.0%. Kaplan-Meier survival curves identified the first postoperative year as the highest mortality risk period. The ASAgeCoGeCC Score was the only model in this study that simultaneously demonstrated balanced sensitivity (0.73)/specificity (0.82), excellent discrimination (AUC = 0.84), and good calibration (H-L = 0.36, calibration slope = 0.75). The DeLong test indicated its significantly superior performance compared to the other models ( < 0.01). The NHFS and Holt et al. performed next best. All models except the Sernbo Score achieved AUC values exceeding 0.70. Significant calibration deficiencies were observed in NHFS, HEMA, and SHiPS (Hosmer-Lemeshow < 0.05). Risk stratification analysis revealed SHiPS as the most precise classification system.
ASAgeCoGeCC score, NHFS and Holt et al.showed acceptable predictive performance, where the first two are applicable to clinical rapid decision-making, while NHFS has been extensively external validated. Holt et al.is more suitable for a well-resourced medical system. SHiPS displayed optimal risk categorization accuracy, suggesting potential for broader clinical implementation. These findings necessitate verification through prospective multi-center studies.
本研究系统评估了七种风险分层模型对老年脆性髋部骨折患者术后12个月死亡率的预测能力，同时评估了它们的风险分类准确性，以为围手术期方案制定、康复策略和预后管理提供依据。
目前的临床实践缺乏针对老年脆性髋部骨折患者死亡率风险预测的标准化标准。本调查对七种预后模型进行了比较评估，即Sernbo评分、Jiang等人的模型、诺丁汉髋部骨折评分（HFS）、Holt等人的算法、HEMA、ASAgeCoGeCC评分以及SHiPS-HiPSe、SHire和SHim、HEMA、ham髋部骨折评分（老年脆性髋部骨折患者的死亡率风险预测）。
在这项回顾性队列分析中，纳入了2018年1月至2022年10月期间所有连续的老年脆性髋部骨折患者。计算模型得出的死亡率预测和风险分类。通过预测有效性、受试者操作特征（ROC）曲线下面积（AUC）分析、DeLong检验、Hosmer-Lemeshow拟合优度检验和校准斜率（95%置信区间）对预测性能进行量化，随后对风险分层层级进行精确评估。
该队列的12个月死亡率为29.0%。Kaplan-Meier生存曲线确定术后第一年是死亡率风险最高的时期。ASAgeCoGeCC评分是本研究中唯一同时表现出平衡的敏感性（0.73）/特异性（0.82）、出色的区分度（AUC = 0.84）和良好校准（H-L = 0.36，校准斜率 = 0.75）的模型。DeLong检验表明其性能明显优于其他模型（<0.01）。NHFS和Holt等人的模型表现次之。除Sernbo评分外，所有模型的AUC值均超过0.70。在NHFS、HEMA和SHiPS中观察到明显的校准缺陷（Hosmer-Lemeshow < 0.05）。风险分层分析显示SHiPS是最精确的分类系统。
ASAgeCoGeCC评分、NHFS和Holt等人的模型显示出可接受的预测性能，前两者适用于临床快速决策，而NHFS已得到广泛的外部验证。Holt等人的模型更适合资源充足的医疗系统。SHiPS显示出最佳的风险分类准确性，表明有更广泛临床应用的潜力。这些发现需要通过前瞻性多中心研究进行验证。
