Application Value And Prognostic Analysis Of Optimized Preoperative Evaluation System In Elderly Hip Fracture

Background:Hip fracture is one of the important factors threatening health of the elderly.Compared with young patients,older patients are at greater risk of surgery and have a worse prognosis.How to accurately assess the patient's surgical risk and prognosis is a difficult problem for doctors and patients.Studies have shown that POSSUM can accurately predict surgical complications,but overestimate mortality,P-POSSUM overcomes this shortcoming,but overestimates complications.They have the same evaluation items,but different statistical methods.It is possible to predict operative complications and mortality more accurately by combining the two methods in the same case.ACS NSQIP is an open and standardized risk assessment system,which is widely used abroad.However,it is rarely reported to evaluate the surgical risk of elderly patients with hip fracture.There are many factors affecting the prognosis of elderly patients with hip fracture,it not be ignored that further clarifying the possible factors affecting the long-term prognosis.Objective:To explore the accuracy of POSSUM combined with P-POSSUM in predicting30-day complications and mortality in elderly patients with hip fracture,and compared with ACS-NSQIP,meanwhile to explore the key factors influencing the prognosis of elderly patients with hip fracture in 6 months after operation.Method:All patients aged 65 years or older who suffered from hip fracture due to low energy injury in trauma surgery of XiJing Hospital from July 1,2017 to August 31,2018were selected.The complications and mortality risk of each patient were calculated by POSSUM,P-POSSUM and ACS NSQIP evaluation systems.Comparing the observed with the evaluated(O:E),judging the accuracy of different evaluation systems.At the same time,refer to the"Present Assessment of Chinese Experts for Elderly Patients"and related literature,group patients according to Harris score,and analyze the key factors that may affect the prognosis of surgery for 6 months.Result:Ninety-five patients were enrolled.Six of them chose conservative treatment because of the high risk of operation,and three patients were lost due to the change of contact mode.Finally,86 subjects were included in the analysis.There were 24 males(27.90%)and 62 females(72.10%).POSSUM predicted complications was 46 cases,observed was 20 patients,O:E=0.43.The difference between the predicted and the observed was statistically significant(?~2=4.85,P=0.02).P-POSSUM predicted death was6 cases,actual death was 2 patients,O:E=0.33.There was no significant difference between the predicted and the observed(Fisher test,P=0.14).ACS NSQIP predicted 11cases of complications,20 cases of actual occurrence,O:E=1.82.There was no significant difference between predicted and observed(Fisher test,P=0.12).ACS NSQIP predicted 3 deaths,2 actual deaths,O:E=0.67.There was no significant difference between predicted and observed(Fisher test,P=0.07).The patients were divided into good prognosis group and bad prognosis group according to Harris score.Logistic regression analysis showed that low ADL score,low hemoglobin level and high globulin level might be closely related to poor prognosis.ROC curve was used to test the predictive probability of ADL,hemoglobin and globulin for adverse prognosis.The results showed that the combination of the three factors had the strongest predictive ability.The area under the curve was 0.88,95%CI(0.79-0.98),P<0.01.Conclusion:1.POSSUM combined with P-POSSUM failed to accurately predict the complication and mortality of hip fractures in the elderly;2.ACS NSQIP can accurately predict the complication and mortality of hip fractures in the elderly;3.Low ADL score,low hemoglobin and high globulin may be closely related to the long-term adverse prognosis of hip fracture surgery in the elderly.The combination of the three indexes is a good indicator for predicting the adverse prognosis of hip fracture in the elderly at 6months after surgery.