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. 2021 Sep 26:12:21514593211036235.
doi: 10.1177/21514593211036235. eCollection 2021.

Developing a Simpler Prognosticating Tool: Comparing the Combined Assessment of Risk Encountered in Surgery Score with Deyo-Charlson Comorbidity Index and The American Society of Anesthesiologists Physical Status Score in Predicting 2 years Mortality after Hip Fracture Surgery

Eric Wei Liang Cher  1 , John Allen Carson  2 , Eileen Yilin Sim  3 , Hairil Rizal Abdullah  3 , Tet Sen Howe  1 , Joyce Koh Suang Bee  1
Affiliations

Developing a Simpler Prognosticating Tool: Comparing the Combined Assessment of Risk Encountered in Surgery Score with Deyo-Charlson Comorbidity Index and The American Society of Anesthesiologists Physical Status Score in Predicting 2 years Mortality after Hip Fracture Surgery

Eric Wei Liang Cher et al. Geriatr Orthop Surg Rehabil. .

Abstract

Background: The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo-Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. Methods and Material: A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015. Age, gender, time to surgery, ASA-PS score, D-CCI, and CARES score were obtained. Univariate and multivariable logistic regression analyses were used to assess statistical significance of scores and risk factors, and area under the receiver operating characteristic (ROC) curve (AUC) was used to compare ASA-PS, D-CCI, and CARES as predictors of mortality at 2 years. Results: 763 surgically treated hip fracture patients were included in this study. The 2-year mortality rate was 13.1% (n = 100), and the mean ± SD CARES score of surviving and demised patients was 21.2 ± 5.98 and 25.9 ± 5.59, respectively. Using AUC, CARES was shown to be a better predictor of 2-year mortality than ASA-PS, but we found no statistical difference between CARES and D-CCI. A CARES score of 23, attributable primarily to pre-surgical morbidities and poor health of the patient, was identified as the statistical threshold for "high" risk of 2-year mortality. Conclusion: The CARES score is a viable risk predictor for 2-year mortality following hip fracture surgery and is comparable to the D-CCI in predictive capability. Our results support the use of a simpler yet clinically relevant CARES in prognosticating mortality following hip fracture surgery, particularly when information on the pre-existing comorbidities of the patient is not immediately available.

Keywords: ASA; Charlson Comorbidity Index; Combined Assessment of Risk Encountered in Surgery; comorbidity index; geriatric; hip fracture; mortality; risk stratification.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Death: Total ratio at 2 years follow-up after hip fracture surgery.
Figure 2.
Figure 2.
Comparisons of ROC curves for the American Society of Anesthesiologists physical status, Deyo–Charlson Comorbidity Index, and CARES in predicting 2-year mortality.
See this image and copyright information in PMC

References

    1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-1733. doi: 10.1007/s00198-006-0172-4 - DOI - PubMed
    1. Cheung C-L, Ang SB, Chadha M, Chow ES-L, Chung Y-S, Hew FL, et al. An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporosis Sarcopenia. 2018;4(1):16-21. doi: 10.1016/j.afos.2018.03.003 - DOI - PMC - PubMed
    1. Mohd Tahir N, Thomas P, Li S. Burden of osteoporosis-related hip fracture in Asia. A review of health care costs and resource utilization. Value Health. 2016;19(7):A916. doi: 10.1016/j.jval.2016.08.108 - DOI
    1. Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, et al. The aftermath of hip fracture: Discharge placement, functional status change, and mortality. Am J Epidemiol. 2009;170(10):1290-1299. doi: 10.1093/aje/kwp266 - DOI - PMC - PubMed
    1. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. J Am Med Assoc. 2009;302(14):1573-1579. doi: 10.1001/jama.2009.1462 - DOI - PMC - PubMed