Journal Article

Development and validation of a risk prediction model for severe postoperative complications in elderly patients with hip fracture

Jiang, Lian, Chen, Xiao, Wei, Zhihui, Zhang, Minghua

2024

Overview

This study aimed to investigate risk factors associated with severe postoperative complications following hip fracture surgery in elderly patients and to develop a nomogram-based risk prediction model for these complications. A total of 627 elderly patients with hip fractures treated at Yongchuan Hospital of Chongqing Medical University from January 2015 to April 2024 were collected. 439 patients were assigned to the training cohort for model development, and 188 to the validation cohort for model assessment. The training cohort was stratified based on the presence or absence of severe complications. We employed LASSO regression, as well as univariate and multivariate logistic regression analyses, to identify significant factors. A nomogram was constructed based on the outcomes of the multivariate regression. The model's discriminative ability was assessed using the area under the receiver operating characteristic curve (AUC), while calibration plots and decision curve analysis (DCA) evaluated its calibration and stability. Internal validation was performed using the validation cohort. Out of the 627 patients, 118 (18.82%) experienced severe postoperative complications. Both LASSO regression and multivariate logistic analysis identified the modified 5-item frailty index (mFI-5) and the preoperative C-reactive protein to albumin ratio (CAR) as significant predictors of severe complications. The nomogram model, derived from the multivariate analysis, exhibited strong discriminative ability, with an AUC of 0.963 (95% CI: 0.946-0.980) for the training cohort and 0.963 (95% CI: 0.938-0.988) for the validation cohort. Calibration plots demonstrated excellent agreement between the nomogram's predictions and actual outcomes. Decision curve analysis (DCA) indicated that the model provided clinical utility across all patient scenarios. These findings were consistent in the validation cohort. Both the mFI-5 and CAR are predictive factors for severe postoperative complications in elderly patients undergoing hip fracture surgery.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Aged patients / Aged, 80 and over / Albumin / Anesthesia / Biology and Life Sciences / Body mass index / C-reactive protein / C-Reactive Protein - analysis / C-Reactive Protein - metabolism / Calibration / Care and treatment / Chronic obstructive pulmonary disease / Complications / Data collection / Dexmedetomidine / Female / Forecasts and trends / Fractures / Frailty / Heart failure / Hemoglobin / Hip / Hip Fractures - surgery / Hip joint / Hospital patients / Hospitals / Humans / Kidney diseases / Male / Medical colleges / Medical personnel / Medical research / Medicine and Health Sciences / Medicine, Experimental / Mortality / Multivariate analysis / Nomograms / Older people / Patients / Physical Sciences / Physiology / Postoperative / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Prediction models / Predictions / Proteins / Regression analysis / Regression models / Research and Analysis Methods / Risk Assessment - methods / Risk Factors / ROC Curve / Stability analysis / Surgery / Surgical outcomes / Thrombosis / Training / Trauma / Triglycerides / Variables