| Objectives1.To understand the current situation of contralateral hip re-fracture in elderly patients after hip fracture surgery;2.To explore the risk factors related to re-fracture of the contralateral hip in elderly patients with hip fracture after surgery;3.To construct a risk prediction model for contralateral hip re-fracture in elderly patients with hip fracture,and to verify the predictive ability of the model.MethodsThis study is divided into two phases:1.To extract the related risk factors of contralateral hip re-fracture in elderly patients with hip fracture.systematically search domestic and foreign databases for research on the risk factors of contralateral hip re-fracture in elderly patients after hip fracture surgery,and conduct quality assessment and data extraction of the included studies.The risk factors of refolding were analyzed in Rev Man5.3 statistical software,and the OR value and the 95%CI were used to represent the effect size.Results were analyzed by I~2test for heterogeneity;funnel plot was used to test for publication bias;fixed-effect and random-effects models were used to test the stability of results.2.To construct a risk prediction model for contralateral hip re-fracture in elderly patients with hip fracture,and to verify the predictive ability of the model.Hip Refold Information Questionnaire.A retrospective analysis was performed on patients aged≥60 years after hip fracture surgery in a grade A hospital of Tianjin from January 2014 to December 2020.Based on the risk factors obtained from the first stage meta-analysis,referring to the general information,examination results and other medical record information of patients with hip fractures in clinic,we designed and compiled the"Contralateral Postoperative Patients with Hip Fractures in the Elderly".Information was collected by review of electronic case information and telephone follow-up.According to the chronological order of patient discharge,2/3 patients entered the modeling group and 1/3patients entered the validation group.Univariate and binary logistic regression analyses were used to screen risk factors for inclusion in the model.Taking the occurrence of refolding as the dependent variable and independent risk factors as the independent variables,a refolding risk prediction model was established and presented in the form of a nomogram.The discrimination ability of the model was assessed by ROC curve;the classification degree of the model was assessed by sensitivity,specificity,positive predictive value and negative predictive value;the conformity of the model was assessed by drawing a calibration chart;the clinical validity of the model was assessed by decision curve analysis.evaluate.Results1.Meta-analysis results:A total of 26 literatures were included in this study,including22 case-control studies and 4 cohort studies.A total of 13,817 elderly hip fracture patients were included in the study,of which 1,189 patients experienced refracture after surgery.The results showed that in a case-control study,gender(OR=1.36,95%CI[1.17,1.58]),age(MD=5.17,95%CI[4.23,7.31]),fracture type(OR=1.85,95%CI[1.10,3.13]),osteoporosis(OR=3.68,95%CI[2.76,4.92]),diabetes(OR=1.90,95%CI[1.49,2.42]),Parkinson’s disease(OR=4.53,95%CI[2.95,6.94]),cerebrovascular disease(OR=2.89,95%CI[2.10,3.96]),visual impairment(OR=2.28,95%CI[1.71,3.04]),rheumatoid arthritis(OR=2.44,95%CI[1.67,3.57]),hypertension(OR=1.96,95%CI[1.23,3.14]),Alzheimer’s disease(OR=3.01,95%CI[2.10,4.32]),anti-bone There are 13 factors such as osteoporosis treatment(OR=2.83,95%CI[1.55,5.19]),no functional exercise after surgery(OR=3.94,95%CI[2.76,5.64])and other 13 factors P<0.05,which is considered to be related to the elderly hip.Refracture of the contralateral hip was significantly associated with postoperative contralateral hip fractures in patients with hip fractures;in the cohort study,gender(OR=1.69,95%CI[1.28,2.24]),age(MD=2.06,95%CI[0.41,3.70])The two factors,P<0.05,were considered to be significantly related to the occurrence of refracture of the contralateral hip in elderly patients with hip fracture.2.Retrospective findings:A total of 645 hip fracture patients were included in this study,of which 1097 patients entered the modeling group and 548 patients entered the validation group.Among the 1645 hip fracture patients,130 patients had contralateral hip re-fracture,the incidence was 7.9%,and the mean age was 77.8 years.There were 29 males and 101 females,84 femoral neck fractures and 46 intertrochanteric fractures.3.Construction of risk prediction model:In univariate analysis,the two groups were significantly different in age,length of hospital stay,Harris score,≥2 comorbidities,diabetes,heart disease,anemia,Alzheimer’s disease,Parkinson’s disease,visual impairment,rheumatoid joint There was statistical significance in inflammation and functional exercise(P<0.05).Seven independent risk factors for re-fracture of the contralateral hip in elderly patients after hip fracture surgery were obtained by multivariate analysis,namely advanced age,low Harris score,combined with Alzheimer’s disease,combined with Parkinson’s disease,combined with visual impairment,combined with heart disease Disease,no functional exercise after surgery.The above 7 variables were used as predictors,and the logistic regression coefficient of each variable was used as its weight in the overall prediction model to establish a re-fracture nomogram risk prediction model.Hosmer-Lemeshow test showedχ~2=8.967,P=0.175.The area under the ROC curve of the modeling group was AUC=0.776,95%CI[0.727,0.825],the specificity was 73.6%,and the sensitivity was 72.2%,the positive predictive value was 18.3%,the negative predictive value was 96.6%,and the prediction accuracy was 71.2%.4.Validation of the risk prediction model:The area under the ROC curve of the validation group was AUC=0.815,95%CI[0.743,0.887],the specificity was 70.1%,the sensitivity was 75%,the positive predictive value was 16.5%,the negative predictive value was 97.3%,and the predictive accuracy was 70.4%.The calibration curve shows a small deviation between the prediction result and the actual observation result,which indicates that the prediction accuracy of the model is high.The decision curve shows that the model has practical clinical application value and patients can benefit from it.Conclusions1.Meta-analysis results showed that women,advanced age,Primary fracture type is femoral neck fracture,combined with osteoporosis,diabetes,Parkinson’s disease,cerebrovascular disease,visual impairment,rheumatoid arthritis,hypertension,heart disease,Alzheimer’s disease,uncontrolled Fourteen factors,such as receiving anti-osteoporosis treatment and not performing functional exercise after surgery,are the risk factors for re-fracture of the contralateral hip in elderly patients with hip fracture.This study has a small publication bias and relatively stable results,providing an evidence-based basis for the establishment of risk prediction models for re-fracture.2.The risk prediction model of contralateral hip re-fracture in elderly patients with hip fractures includes 7 variables including age,Harris score,Alzheimer’s,Parkinson’s,visual impairment,heart disease,and postoperative rehabilitation exercise.The validation results show that the model has good predictive efficacy and can help clinicians to preliminarily evaluate the risk of contralateral hip re-fracture in elderly patients after hip fracture surgery. |
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