Prognostic Factors And Prediction On The Post-operative Elders With Hip Fracture

Objective1.To study the overall prognosis of elderly patients with hip fracture surgery,and to explore the main factors that influenced the hip joint function rehabilitation and daily life function recovery at three months after operation.2.To compare the prediction effect of Krishnan comprehensive frailty index and CSHA frailty index on the postoperative death,hip function recovery and daily life function recovery of elderly patients with hip fracture surgery and the correlation studies.Methods1.This study adopted the clinical follow-up and observational methods.Patients older than 60 years who receive hip fracture surgery in the first affiliated hospital of Fujian medical universityfrom November,2015 to November 2016 was included in the study.The basic information of the patients was collected through face to face consultation or reviewing the medical records within 72 hours after hospitalization.Krishnan comprehensive frailty index and CSHA frailty index were used for evaluating patients' weak condition.Assay index will be subject to the last test preoperation.Instruction and telephone follow-up were done at the time of leaving hospital and 1 month,3months after operation.The incident of complication and death were recorded 3 months after operation and JOA and FRS were used for the evaluation of functional recovery of the hip and patients daily life at 3 months.2.Statistical analysis: Using single factor and multi-factor linear regression for analyzing the adverse factors that affected the prognosis,and using the area under the ROC curve and Pearson correlation coefficient to compare the prediction effect of the two frailty index on the postoperative death,functional recovery of the hipand patients daily life.Result1.The overall prognosis: A total of 130 cases of elder hip fracture patients were included in the study with 34 male patients and 87 female patients.The average age was 77.54±8.49 years old.125(96.2%)patients had comorbidities preoperation.7 patients died and 103 patients had complication at follow-up.The average JOA score for the hip was 67.33±18.21 and the FRS score was 65.92±22.79 at 3 months.2.Adverse prognostic factors of the recovery of hip function: The results found that gender(t =-3.251,P = 0.001),and the Barthel rating before fracture(t = 2.134,P = 0.035),the number of preoperative comorbidities(t =-2.078,P = 0.040)were the independent risk factors that effect the recovery of hip function in elderly patients with hip fracture by using single factor and multi-factor linear regression analysis;3.Adverse prognostic factors of the postoperative functional recovery of activities daily life: Using single factor and multi-factor linear regression analysis,the results found that the operation mode(t = 2.590,P = 0.011),and the Barthel rating before the fracture(t =-4.185,P < 0.001),the number of the postoperative complications(t =-3.743,P < 0.001)are independent risk factors for postoperative functional recovery of FRS daily life.4.The comparison of predictingefficiency between the two frailty index: The area under the ROC curve was used to determine the Krishnan comprehensive frailty index score(AUC = 0.856;95% CI = 0.767-0.945)and the CSHA frailty index score(AUC = 0.793;95% CI = 0.652-0.934)to predict the effect of the patients died,the two prediction were statistically significant(P < 0.01).But the prediction efficiency of Krishnan comprehensive frailty index was better than CSHA frailty index.The best death predicted value of Krishnan comprehensive frailty index and CSHA frailty index is 0.335,0.28.The Pearson correlation coefficient analysis revealed that the Krishnan comprehensive frailty index score and JOA score correlation(R =-0.249,P = 0.005),and the CSHA frailty index score had no statistically significant correlation with JOA scores(R =-0.125,P = 0.170).Krishnan comprehensive frailty index score(R =-0.415,P < 0.001),CSHA frailty index score(R =-0.332,P < 0.001)and the correlation of FRS scores were statistically significant.Conclusions1.Elderly hip fracture patients suffer high incidence rate of postoperative death and complications.The adverse prognostic factors that influenced the hip functional recovery were gender,the Barthel rating before fracture and number of preoperative comorbidities;Adverse prognostic factors that influenced the functional recovery of daily life was operation method,the Barthel rating before fracture and the number of complications.2.Frailty index inversely related with the recovery of hip function and the postoperative functional recovery of activities daily life.The prediction efficiency of Krishnan comprehensive frailty index on postoperative death,hip function and daily life functional recovery in elderly patients with hip fracture was better than CSHA frailty index,we suggest that using Krishnan comprehensive frailty index to predict the prognosis in elderly patients with hip fracture surgery.When the Krishnan comprehensive frailty index score is above 0.335,the postoperative patient's risk of death may be increased.In consequence,medical staff should pay attention to patient's FI.