Rapid preoperative predicting tools for 1-year mortality and walking ability of Asian elderly femoral neck fracture patients who planned for hip arthroplasty
Autor: | Hao Wang, Qiujian Zheng, Yunlian Xue, Yuanchen Ma, Guangtao Fu, Ruiying Zhang, Mengyuan Li |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty Prognosis prediction Arthroplasty Replacement Hip Diseases of the musculoskeletal system Walking Logistic regression Femoral Neck Fractures 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Derivation Mortality Femoral neck Aged Retrospective Studies Orthopedic surgery Aged 80 and over 030222 orthopedics Femoral neck fracture business.industry Recovery of Function Nomogram Hip arthroplasty Nomograms medicine.anatomical_structure RC925-935 Preoperative Period Physical therapy Walking ability Surgery Female Hemiarthroplasty 1 year mortality business RD701-811 Research Article |
Zdroj: | Journal of Orthopaedic Surgery and Research Journal of Orthopaedic Surgery and Research, Vol 16, Iss 1, Pp 1-11 (2021) |
ISSN: | 1749-799X |
Popis: | Background Femoral neck fractures in elderly patients typically warrant operative treatment and are related to high risks of mortality and morbidity. As early hip arthroplasties for elderly femoral neck fractures are widely accepted, rapid predicting models that allowed quantitative and individualized prognosis assessments are strongly needed as references for orthopedic surgeons during preoperative conversations. Methods Data of patients aged ≥ 65 years old who underwent primary unilateral hemiarthroplasty or total hip arthroplasty due to femoral neck fracture between January 1st, 2012 and June 30th, 2019 in our center were collected. Candidate variables included demographic data, comorbidities, and routine preoperative screening tests. The main outcomes included 1-year mortality and free walking rate after hip arthroplasty. Patients were randomly divided into derivation and validation groups in the ratio of three to one. Nomograms were developed based on multivariable logistic regressions of derivation group via R language. One thousand bootstraps were used for internal validation. Those models were further tested in the validation group for external validation. Results The final analysis was performed on 702 patients after exclusion and follow-up. All-cause 1-year mortality of the entire data set was 23.4%, while the free walking rate was 57.3%. Preoperative walking ability showed the biggest impact on predicting 1-year mortality and walking ability. Static nomograms were created from the final multivariable models, which allowed simplified graphical computations for the risks of 1-year mortality and walking ability in a certain patient. The bias-corrected C index of those nomograms for predicting 1-year mortality in the derivation group and the validation group were 0.789 and 0.768, while they were 0.807 and 0.759 for predicting postoperative walking ability. The AUC of the mortality and walking ability predicting models were 0.791 and 0.818, respectively. Conclusions Our models enabled rapid preoperative 1-year mortality and walking ability predictions in Asian elderly femoral neck fracture patients who planned for hip arthroplasty, with adequate predictive discrimination and calibration. Those rapid assessment models could help surgeons in making more reasonable clinical decisions and subsequently reducing the risk of potential medical dispute via quantitative and individualized prognosis assessments. |
Databáze: | OpenAIRE |
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