Establishment And Application Of Orthopedics Operative Risks Scoring System For Elderly Patients With Hip Fractures

ObjectiveAfter studying all the operative risks for elderly patients with.hip fractures retrospectively, we established a simple, objective and applicable physiological and operative severity score for elderly patients with hip fractures (POSSHF) based on physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) to predict complications morbidity and mortality, and compare POSSHF with POSSUM.MethodsAfter studying papers and consulting experts with questionnaires,31operative risks were set. POSSHF was established on the basis of31operative risks and POSSUM. Retrospectively study272patients who received orthopedic surgery from January2009to December2011with POSSHF and Logistic regression analysis yielded a statistically significant equation for complications morbidity:In R/(1-R)=-5.051+0.141×PS+0.108×OS (R:complications morbidity, PS:physiological score, OS:operative severity score). Then, evaluate108patients from June2012to June2013with POSSHF and POSSUM. The predictive power of complications morbidity based on POSSHF and POSSUM were compared.Results1. Surgical treatment, surgical time, hemoglobin and serum sodium were independent risk factors to predict complications morbidity of elderly patients with hip fractures.2. Complications morbidity predicted by POSSHF was5.10%-63.60%(average14.01%). There was no statistical significance between predictive value (P=16) and actual value (F=23)(P=0.216). Complications morbidity predicted by POSSUM was11.70%-88.80%(average47.01%. There was statistical significance between predictive value (P=51) and actual value (F=23)(P=0.000).3. POSSHF model for complications morbidity had0.658in C-index,87.00%in sensitivity,35.30%in specificity and46.30%in coincidence rate, while POSSUM model for complications morbidity had0.628in C-index,82.60%in sensitivity,42.40%in specificity and50.90%in coincidence rate.ConclusionPOSSHF could generate a significant regression model for complications morbidity of elderly patients with hip fractures, but failed to establish an equation for mortality. Compared POSSHF with POSSUM, their predictive power were both not that good, but POSSHF was simpler, more objective and applicable which needs to be tested with further studies.