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New Equations for Predicting Postoperative Risk in Patients with Hip Fracture

  • Jun HiroseEmail author
  • Junji Ide
  • Hiroki Irie
  • Kenshi Kikukawa
  • Hiroshi Mizuta
Original Article

Abstract

Predicting the postoperative course of patients with hip fractures would be helpful for surgical planning and risk management. We therefore established equations to predict the morbidity and mortality rates in candidates for hip fracture surgery using the Estimation of Physiologic Ability and Surgical Stress (E-PASS) risk-scoring system. First we evaluated the correlation between the E-PASS scores and postoperative morbidity and mortality rates in all 722 patients surgically treated for hip fractures during the study period (Group A). Next we established equations to predict morbidity and mortality rates. We then applied these equations to all 633 patients with hip fractures treated at seven other hospitals (Group B) and compared the predicted and actual morbidity and mortality rates to assess the predictive ability of the E-PASS and Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) systems. The ratio of actual to predicted morbidity and mortality rates was closer to 1.0 with the E-PASS than the POSSUM system. Our data suggest the E-PASS scoring system is useful for defining postoperative risk and its underlying algorithm accurately predicts morbidity and mortality rates in patients with hip fractures before surgery. This information then can be used to manage their condition and potentially improve treatment outcomes.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Postoperative Morbidity Inhospital Mortality Postoperative Risk Displace Femoral Neck Fracture Comprehensive Risk Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Drs. Hiroshi Usui, Yuri Yabuki (NHO Tokyo Medical Center), Yukio Nakatsuchi, Yutaka Tateiwa (NHO Nagano National Hospital), Toshiaki Miyahara, Taro Mawatari (NHO Kyusyu Medical Center), Satoshi Motokawa, Kiyofumi Mitsutake (NHO Nagasaki Medical Center), Kazuhiko Ihara (NHO Beppu Medical Center), Satoshi Maeda (NHO Kumamoto Medical Center), and Tateki Segata (NHO Kumamoto Saisyunso National Hospital) for supplying patient data. We also thank Dr. Haga (NHO Kumamoto Medical Center) for technical advice on statistics.

References

  1. 1.
    Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–553.CrossRefPubMedGoogle Scholar
  2. 2.
    Charles C, Whelan T, Gafni A. What do we mean by partnership in making decisions about treatment? BMJ. 1999;319:780–782.PubMedGoogle Scholar
  3. 3.
    Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78:355–360.CrossRefPubMedGoogle Scholar
  4. 4.
    Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol. 2003;56:788–795.CrossRefPubMedGoogle Scholar
  5. 5.
    French DD, Bass E, Bradham DD, Campbell RR, Rubenstein LZ. Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc. 2008;56:705–710.CrossRefPubMedGoogle Scholar
  6. 6.
    Haga Y, Ikei S, Ogawa M. Estimation of Physiologic Ability and Surgical Stress (E-PASS) as a new prediction scoring system for postoperative morbidity and mortality following elective gastrointestinal surgery. Surg Today. 1999;29:219–225.CrossRefPubMedGoogle Scholar
  7. 7.
    Haga Y, Wada Y, Takeuchi H, Kimura O, Furuya T, Sameshima H, Ishikawa M. Estimation of Physiologic Ability and Surgical Stress (E-PASS) for a surgical audit in elective digestive surgery. Surgery. 2004;135:586–594.CrossRefPubMedGoogle Scholar
  8. 8.
    Hirose J, Mizuta H, Ide J, Nakamura E, Takada K. E-PASS for predicting postoperative risk with hip fracture: a multicenter study. Clin Orthop Relat Res. 2008;466:2833–2841.CrossRefPubMedGoogle Scholar
  9. 9.
    Hirose J, Mizuta H, Ide J, Nomura K. Evaluation of Estimation of Physiologic Ability and Surgical Stress (E-PASS) to predict the postoperative risk for hip fracture in elder patients. Arch Orthop Trauma Surg. 2008;128:1447–1452.CrossRefPubMedGoogle Scholar
  10. 10.
    Jarman B, Aylin P, Bottle A. Discharge destination and length of stay: differences between US and English hospitals for people aged 65 and over. BMJ. 2004;328:605.CrossRefPubMedGoogle Scholar
  11. 11.
    Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, Johnston DW. Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res. 2005;20:494–500.CrossRefPubMedGoogle Scholar
  12. 12.
    Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726–1733.CrossRefPubMedGoogle Scholar
  13. 13.
    Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality: relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984;186:45–56.PubMedGoogle Scholar
  14. 14.
    Masuda T, Miura N, Ishii S, Hibino Y, Beppu M. New preoperative evaluation system of the physical findings of aged patients with femoral neck fracture. J Orthop Sci. 2004;9:434–439.CrossRefPubMedGoogle Scholar
  15. 15.
    Mohamed K, Copeland GP, Boot DA, Casserley HC, Shackleford IM, Sherry PG, Stewart GJ. An assessment of the POSSUM system in orthopaedic surgery. J Bone Joint Surg Br. 2002;84:735–739.CrossRefPubMedGoogle Scholar
  16. 16.
    Nguyen-Oghalai TU, Kuo YF, Zhang DD, Graham JE, Goodwin JS, Ottenbacher KJ. Discharge setting for patients with hip fracture: trends from 2001 to 2005. J Am Geriatr Soc. 2008;56:1063–1068.CrossRefPubMedGoogle Scholar
  17. 17.
    Oka Y, Nishijima J, Oku K, Azuma T, Inada K, Miyazaki S, Nakano H, Nishida Y, Sakata K, Izukura M. Usefulness of an Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system to predict the incidence of postoperative complications in gastrointestinal surgery. World J Surg. 2005;29:1029–1033.CrossRefPubMedGoogle Scholar
  18. 18.
    Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–655.CrossRefPubMedGoogle Scholar
  19. 19.
    Oskvig RM. Special problems in the elderly. Chest. 1999;115:158S–164S.CrossRefPubMedGoogle Scholar
  20. 20.
    Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–243.CrossRefPubMedGoogle Scholar
  21. 21.
    Parker MJ, Pryor GA, Myles J. 11-year results in 2,846 patients of the Peterborough Hip Fracture Project: reduced morbidity, mortality and hospital stay. Acta Orthop Scand. 2000;71:34–38.CrossRefPubMedGoogle Scholar
  22. 22.
    Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ. POSSUM and Portsmouth POSSUM for predicting mortality: Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity. Br J Surg. 1998;85:1217–1220.CrossRefPubMedGoogle Scholar
  23. 23.
    Ramanathan TS, Moppett IK, Wenn R, Moran CG. POSSUM scoring for patients with fractured neck of femur. Br J Anaesth. 2005;94:430–433.CrossRefPubMedGoogle Scholar
  24. 24.
    Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374.CrossRefPubMedGoogle Scholar
  25. 25.
    Sakamoto K, Nakamura T, Hagino H, Endo N, Mori S, Muto Y, Harada A, Nakano T, Yamamoto S, Kushida K, Tomita K, Yoshimura M, Yamamoto H. Report on the Japanese Orthopaedic Association’s 3-year project observing hip fractures at fixed-point hospitals. J Orthop Sci. 2006;11:127–134.CrossRefPubMedGoogle Scholar
  26. 26.
    Towle A, Godolphin W. Framework for teaching and learning informed shared decision making. BMJ. 1999;319:766–771.PubMedGoogle Scholar
  27. 27.
    Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J. Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res. 2003;18:2231–2237.CrossRefPubMedGoogle Scholar
  28. 28.
    Whiteley MS, Prytherch DR, Higgins B, Weaver PC, Prout WG. An evaluation of the POSSUM surgical scoring system. Br J Surg. 1996;83:812–815.CrossRefPubMedGoogle Scholar
  29. 29.
    Wijesinghe LD, Mahmood T, Scott DJ, Berridge DC, Kent PJ, Kester RC. Comparison of POSSUM and the Portsmouth predictor equation for predicting death following vascular surgery. Br J Surg. 1998;85:209–212.CrossRefPubMedGoogle Scholar
  30. 30.
    Wright DM, Blanckley S, Stewart GJ, Copeland GP. The use of orthopaedic POSSUM as an audit tool for fractured neck of femur. Injury. 2008;39:430–435.CrossRefPubMedGoogle Scholar
  31. 31.
    Yamashita S, Haga Y, Nemoto E, Nagai S, Ohta M. E-PASS (The Estimation of Physiologic Ability and Surgical Stress) scoring system helps the prediction of postoperative morbidity and mortality in thoracic surgery. Eur Surg Res. 2004;36:249–255.CrossRefPubMedGoogle Scholar
  32. 32.
    Young W, Seigne R, Bright S, Gardner M. Audit of morbidity and mortality following neck of femur fracture using the POSSUM scoring system. N Z Med J. 2006;119:U1986.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Jun Hirose
    • 1
    Email author
  • Junji Ide
    • 1
  • Hiroki Irie
    • 1
  • Kenshi Kikukawa
    • 1
  • Hiroshi Mizuta
    • 1
  1. 1.Department of Orthopaedic and Neuro-Musculoskeletal Surgery, Faculty of Medical and Pharmaceutical SciencesKumamoto UniversityKumamotoJapan

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