Flávio Cruz Ferro, Marcos Adriano Garcia Campos, Thais Caroline Silva Picolli, Vania de Sá Mayoral, Victoria Moralez Soares, Jessica Caroline Ferreira, Lucas Dias Borges Peres, Theodor Terra Mayer Tibeau, Victor El Chihimi Bernardi, David Nascimento Pereira, David Nicoletti Gumieiro, Emilio Carlos Curcelli, Lais Helena Navarro E Lima, Paulo do Nascimento Junior, Taline Lazzarin, Raquel Simões Ballarin, Marina Politi Okoshi, Marcos Ferreira Minicucci, Sergio Alberto Rupp de Paiva, Adam Lee Gordon, Opinder Sahota, Filipe Welson Leal Pereira, Paula Schmidt Azevedo
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This is a cohort study, where perioperative risk screening, including NHFS, was performed at admission, followed by an evaluation of 30-day outcomes. 503 patients were included, 73% female, 79.4 ± 9.3 years old; 58% presented extracapsular and 42% intracapsular fractures, with a 30-day mortality of 9%. The NHFS was higher in the patients who died at 5.6 ± 1.1 compared to survivals at 4.3 ± 1.5 (p-value < 0.001). NHFS > 4 was associated with 30-day mortality observed by Cox regression adjusted by fracture type: HR 4.55 (95% CI 2.10-9.82) (p-value < 0.001) and Kaplan-Meyer Curve (HR 3.94; 95% CI 2.19-7.07; p-value < 0.001). ROC curve showed the accuracy of NHFS in explaining 30-day mortality (AUC 0.74; 95% CI 0.67-0.81). Complications were higher among patients with NHFS > 4. The performance of NHFS was better than the traditional perioperative risk ASA score. Therefore, NHFS can be implemented in real-world clinical practice to estimate the 30-day mortality risk for hip fracture in older patients in Brazil. NHFS > 4 is critical for 30-day mortality and complications; this cutoff helps inform clinical practice. 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引用次数: 0
摘要
围手术期风险评估有助于为老年髋部骨折患者的临床实践提供信息。这是一项队列研究,入院时进行围手术期风险筛查,包括NHFS,然后对30天的结果进行评估。纳入503例患者,女性73%,年龄79.4±9.3岁;58%为囊外骨折,42%为囊内骨折,30天死亡率为9%。死亡5.6±1.1的患者的NHFS高于存活4.3±1.5的患者(经骨折类型校正的Cox回归观察,p值4与30天死亡率相关:HR 4.55 (95% CI 2.10-9.82) (p值4)。NHFS评分优于传统围手术期风险ASA评分。因此,NHFS可以在现实世界的临床实践中实施,以估计巴西老年患者髋部骨折的30天死亡风险。NHFS bbb4对30天死亡率和并发症至关重要;这有助于告知临床实践。本研究可能会激励其他中心在围手术期风险评估常规中考虑NHFS。
Performance of the Nottingham hip fracture score (NHFS) as a predictor of 30-day mortality after proximal femur fracture in an older people Brazilian cohort.
Perioperative risk assessment helps inform clinical practice for older people with hip fractures. This is a cohort study, where perioperative risk screening, including NHFS, was performed at admission, followed by an evaluation of 30-day outcomes. 503 patients were included, 73% female, 79.4 ± 9.3 years old; 58% presented extracapsular and 42% intracapsular fractures, with a 30-day mortality of 9%. The NHFS was higher in the patients who died at 5.6 ± 1.1 compared to survivals at 4.3 ± 1.5 (p-value < 0.001). NHFS > 4 was associated with 30-day mortality observed by Cox regression adjusted by fracture type: HR 4.55 (95% CI 2.10-9.82) (p-value < 0.001) and Kaplan-Meyer Curve (HR 3.94; 95% CI 2.19-7.07; p-value < 0.001). ROC curve showed the accuracy of NHFS in explaining 30-day mortality (AUC 0.74; 95% CI 0.67-0.81). Complications were higher among patients with NHFS > 4. The performance of NHFS was better than the traditional perioperative risk ASA score. Therefore, NHFS can be implemented in real-world clinical practice to estimate the 30-day mortality risk for hip fracture in older patients in Brazil. NHFS > 4 is critical for 30-day mortality and complications; this cutoff helps inform clinical practice. The present study might motivate other centers to consider NHFS in their perioperative risk assessment routine.
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