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. 2018 Feb;42(2):231-238.
doi: 10.1007/s00264-017-3663-3. Epub 2017 Oct 7.

Nutritional markers may identify patients with greater risk of re-admission after geriatric hip fractures

Austin V Stone  1 , Alexander Jinnah  2 , Brian J Wells  3   4   5 , Hal Atkinson  6 , Anna N Miller  7 , Wendell M Futrell  3 , Kristin Lenoir  3 , Cynthia L Emory  8
Affiliations

Nutritional markers may identify patients with greater risk of re-admission after geriatric hip fractures

Austin V Stone et al. Int Orthop. 2018 Feb.

Abstract

Purpose: Osteoporotic hip fractures are increasing in prevalence with the growing elderly population. Morbidity and mortality remain high following osteoporotic hip fractures despite advances in medical and surgical treatments. The associated costs and medical burdens are increased with a re-admission following hip fracture treatment. This study sought to identify demographic and clinical values that may be a predictive model for 30-day re-admission risk following operative management of an isolated hip fracture.

Methods: Between January 1, 2013 and April 30, 2015 all patients admitted to a single academic medical centre for treatment of a hip fracture were reviewed. Candidate variables included standard demographics, common laboratory values, and markers of comorbid conditions and nutrition status. A 30-day, all-cause re-admission model was created utilizing multivariate logistic regression.

Results: A total of 607 patients with hip fractures were identified and met the inclusion criteria; of those patients, 67 were re-admitted within 30 days. Univariate analysis indicates that the re-admission group had more comorbidities (p < 0.001) and lower albumin (p = 0.038) and prealbumin (p < 0.001). The final, reduced model contained 12 variables and incorporated four out of five nutritional makers with an internally, cross-validated C-statistic of 0.811 (95% CI: 0.754, 0.867).

Conclusion: Our results indicate that specific nutritional laboratory markers at the index admission may identify patients that have a greater risk of re-admission after hip fracture. This model identifies potentially modifiable risk factors and may allow orthogeriatricians to better educate patients and better treat post-operative nutritional status and care.

Keywords: Electronic medical records; Hip fracture; Prediction; Re-admission; Risk factors.

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Conflict of interest statement

Conflict of interest Dr. Stone has received research support from Smith & Nephew. Dr. Miller has received financial support from AO North America. Dr. Miller is a board or committee member for the American Academy of Orthopedic Surgery, the American College of Surgeons, the AOTrauma North America, and the Orthopedic Trauma Association. Dr. Miller is also on the editorial or governing board for the Journal of Orthopedic Trauma. Dr. Emory is a paid consultant for BoardVitals. Dr. Emory receives research support from IlluminOss Medical and the Muskuloskeletal Transplant Foundation. Dr. Emory is a board or committee member for the Ruth Jackson Orthopedic Society. Dr. Jinnah, Dr. Wells, Dr. Atkinson, Ms. Lenoir, and Mr. Futrell declare they have no conflicts of interest.

Figures

Fig. 1
Fig. 1. Harrell’s approximation order of all cumulative deleted variables from 0 to 22:
admission, hospital surgery, median income, HGB, LOS, smoking status, AST, BMI, age, platelets, vitamin D, creatinine, race, gender GFR, CCI, protein, ALT, WBC count, albumin, prealbumin, fracture Type
Fig. 2
Fig. 2
The receiver operator characteristic curves displayed demonstrate an equivalent evaluation of the models’ discrimination in a graphical format
Fig. 3
Fig. 3
Calibration curves with standard error and overlaid histogram of predicted probabilities. This shows that both models underestimate risk among the highest risk patients
See this image and copyright information in PMC

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