Eveline de Haan

Not all older patients with hip fractures exhibit frailty and a high risk of complications. Identifying low-risk patients allows more cost-effective treatment strategies. This study aims to identify the patients’ characteristics associated with a reduced risk of major complications following acute hip fracture surgery in elderly patients. A prospective hip fracture database was used to obtain data for this observational cohort study. Complications during hospitalization were categorized as major and minor. Both univariable and multivariable analyses were conducted to determine factors significantly correlated with a hospital stay without major complications in patients of 65 years and older. In total, 2304 patients were analyzed, of whom 771 (33.5%) had one or more major complications. The following characteristics were associated with an uncomplicated hospital stay after hip fracture surgery; age lower than 75 years, female gender, ASA 1 and 2, no history of atrial fibrillation, nor chronic obstructive pulmonary disease, nor dementia, nor Parkinson, nor myocardial infarction, The Katz Index of Independence in activities of daily living (Katz-ADL) of 6, an albumin above 35 g/L and no use of a walking aid. Patients without major complications had significantly shorter hospital stays and lower rates of 30-day and 1-year mortality. This study identifies specific characteristics that can help select patients at low risk for major complications after hip fracture surgery. Patients with a low risk of complications may probably not require extensive geriatric care, enabling more efficient allocation of healthcare resources and contributing to cost reduction.

Aims: The aim of this study was to assess differences in the clinical profile and baseline characteristics between patients with femoral neck fracture (FNF) and trochanteric fracture (TF). The secondary aim was to explore potential differences in clinical outcomes and mortality.Methods: A prospective hip fracture database (FAMMI) was used to obtain data for this observational cohort study. Patients with hip fracture surgery between January 2018 and February 2021 who were aged older than 70 years were prospectively included. Differences between patients with FNF and TF were evaluated by univariable logistic regression. A multivariable analysis was performed to analyze the relationship between type of fracture and mortality, adjusting for potential confounders.Results: In total, 2,089 patients were analyzed, of whom 1,233 (59%) had FNF and 856 (41%) had TF. Patients with TF were older, more often female, had a higher rate of chronic obstructive pulmonary disease and dementia, and had a lower Katz Index of Independence in activities of daily living score. Patients with TF had a lower rate of clinical complications such as delirium, pneumonia, reoperation, or wound infections. No differences in 30-day and one-year mortality were observed, also after multivariable correction.Conclusion: Based on this study, elderly patients with TF exhibit a comparatively inferior baseline status in comparison to patients with FNF. However, patients with TF have lower incidence of postoperative complications. No differences in 30-day and one-year mortality rates were observed between patients with the two types of proximal femoral fractures.Cite this article: Bone Jt Open 2025;6(4):373–382.

Background: The aim of this study was to develop an accurate and clinically relevant prediction model for 30-day mortality following hip fracture surgery. Methods: A previous study protocol was utilized as a guideline for data collection and as the standard for the hip fracture treatment. Two prospective, detailed hip fracture databases of 2 different hospitals (hospital A, training cohort; hospital B, testing cohort) were utilized to obtain data. On the basis of the literature, the results of a univariable analysis, and expert opinion, 26 candidate predictors of 30-day mortality were selected. Subsequently, the training of the model, including variable selection, was performed on the training cohort (hospital A) with use of adaptive least absolute shrinkage and selection operator (LASSO) logistic regression. External validation was performed on the testing cohort (hospital B). Results: A total of 3,523 patients were analyzed, of whom 302 (8.6%) died within 30 days after surgery. After the LASSO analysis, 7 of the 26 variables were included in the prediction model: age, gender, an American Society of Anesthesiologists score of 4, dementia, albumin level, Katz Index of Independence in Activities of Daily Living total score, and residence in a nursing home. The area under the receiver operating characteristic curve of the prediction model was 0.789 in the training cohort and 0.775 in the testing cohort. The calibration curve showed good consistency between observed and predicted 30-day mortality. Conclusions: The Rotterdam Hip Fracture Mortality Prediction-30 Days (RHMP-30) was developed and externally validated, and showed adequate performance in predicting 30-day mortality following hip fracture surgery. The RHMP-30 will be helpful for shared decision-making with patients regarding hip fracture treatment. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Introduction: The aim of our study was to validate the original Charlson Comorbidity Index (1987) (CCI) and adjusted CCI (2011) as a prediction model for 30-day and 1-year mortality after hip fracture surgery. The secondary aim of this study was to verify each variable of the CCI as a factor associated with 30-day and 1-year mortality. Methods: A prospective database of two-level II trauma teaching hospitals in the Netherlands was used. The original CCI from 1987 and the adjusted CCI were calculated based on medical history. To validate the original CCI and the adjusted CCI, the CCI was plotted against the observed 30-day and 1-year mortality, and the area under the curve (AUC) was calculated. Results: A total of 3523 patients were included in this cohort study. The mean of the original CCI in this cohort was 5.1 (SD ± 2.0) and 4.6 (SD ± 1.9) for the adjusted CCI. The AUCs of the prediction models were 0.674 and 0.696 for 30-day mortality for the original and adjusted CCIs, respectively. The AUCs for 1-year mortality were 0.705 and 0.717 for the original and adjusted CCIs, respectively. Conclusions: A higher original and adjusted CCI is associated with a higher mortality rate. The AUC was relatively low for 30-day and 1-year mortality for both the original and adjusted CCIs compared to other prediction models for hip fracture patients in our cohort. The CCI is not recommended for the prediction of 30-day and 1-year mortality in hip fracture patients.

Purpose: The primary objective of this study was to identify new risk factors and to confirm previously reported risk factors associated with 30-day mortality after hip fracture surgery. Patients and methods: A prospective hip fracture database was used to obtain data. In total, 3523 patients who underwent hip fracture surgery between 2011 and 2021 were included. Univariable and multivariable logistic regression was used to screen and identify candidate risk factors. Twenty-seven baseline factors and 16 peri-operative factors were included in the univariable analysis and 28 of those factors were included in multivariable analysis. Results: 8.6% of the patients who underwent hip fracture surgery died within 30 days after surgery. Prognostic factors associated with 30-day mortality after hip fracture surgery were as follows: age 90– 100 years (OR = 4.7, 95% CI: 1.07– 19.98, p = 0.041) and above 100 years (OR = 11.3, 95% CI: 1.28– 100.26, p = 0.029), male gender (OR = 2.6, 95% CI: 1.97– 3.33, p < 0.001), American Society of Anesthesiologists (ASA) 3 and ASA 4 (OR = 2.1, 95% CI: 1.44– 3.14, p < 0.001), medical history of dementia (OR = 1.7, 95% CI: 1.25– 2.36, p = 0.001), decreased albumin level (OR = 0.94, 95% CI: 0.92– 0.97, p < 0.001), decreased glomerular filtration rate (GFR) (OR = 0.98, 95% CI: 0.98– 0.99, p < 0.001), residential status of nursing home (OR = 2.1, 95% CI: 1.44– 2.87, p < 0.001), higher Katz Index of Independence in Activities of Daily Living (KATZ-ADL) score (OR = 1.1, 95% CI: 1.01– 1.16, p=0.018) and postoperative pneumonia (OR = 2.4, 95% CI: 1.72– 3.38, p < 0.001). Conclusion: A high mortality rate in patients after acute hip fracture surgery is known. Factors that are associated with an increased mortality are age above 90 years, male gender, ASA 3 and ASA 4, medical history of dementia, decreased albumin, decreased GFR, residential status of nursing home, higher KATZ-ADL score and postoperative pneumonia.

Purpose: The primary aim of this study was to identify risk factors for delirium after hip fracture surgery. The secondary purpose of this study was to verify peri-operative clinical outcomes, adverse events and mortality rates in delirium patients after hip fracture surgery. Patients and Methods: A prospective hip fracture database was used to obtain data. In total, 2051 patients older than 70 years undergoing a hip fracture surgery between 01– 01-2018 and 01– 01-2021 were included. A delirium was diagnosed by a geriatrician based on the DSM-V criteria. Results: The results showed that 16% developed a delirium during hospital admission. Multivariable analysis showed that male gender (OR: 1.99, p< 0.001), age (OR: 1.06, p< 0.001), dementia (OR: 1.66, p=0.001), Parkinson’s disease (OR: 2.32, p=0.001), Δhaemoglobin loss (OR: 1.19, p=0.022), pneumonia (OR: 3.86, p< 0.001), urinary tract infection (UTI) (OR: 1.97, p=0.001) and wound infection (OR: 3.02, p=0.007) were significant independent prognostic risk factors for the development of a delirium after hip surgery. The median length in-hospital stay was longer in patients with a delirium (9 days) vs patients without a delirium (6 days) (p< 0.001). The 30-day mortality was 7% (with delirium 16% vs with no delirium 6% (p< 0.001)). Conclusion: Significant independent prognostic factors associated with delirium after hip surgery were male gender, age, dementia, Parkinson’s disease, Δhaemoglobin loss, pneumonia, UTI and wound infection.