A formula for predicting postoperative functional decline using routine medical data in elderly patients after hip fracture surgery
A formula for predicting postoperative functional decline using routine medical data in elderly patients after hip fracture surgery
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DOI：
10.1097/bco.0000000000001208
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发表时间：
2023-07-01
影响因子：
0.3
通讯作者：
Horiguchi，Hiromasa
中科院分区：
文献类型：
--
作者：
Fukuda，Taeko;Imai，Shinobu;Horiguchi，Hiromasa
背景：如果无需特殊评估即可预测髋关节手术后的功能下降，那么新治疗和康复实践的效果可以很容易地与之前的病例或其他国家的病例进行比较。本研究的目的是开发和检查一个公式，这样prediction.Methods：数据的3,120例年龄大于65岁的髋部骨折进行了分析。采用Barthel指数评价患者的日常生活活动能力（ADL）。低ADL定义为出院时评分低于入院时评分的患者，以及入院时完全依赖的患者，直到出院才发生变化。在训练样本中开发了三个模型：分别通过输入基本患者数据、基本数据加合并症、基本数据和合并症加8个实验室检查结果和5个生命体征来创建基本、合并症和实验室和生命体征模型。在多变量模型中纳入了单变量分析中统计学显著性< 0.2的所有潜在变量和可能具有临床意义的一些变量。结果：实验室和生命体征公式的c-统计量为0.701，预测值为76.9%。基本公式和Comorbian公式的c-统计量分别为0.643和0.664。将实验室和生命体征公式应用于验证样本，c-统计量为0.663。结论：根据术前常规收集的医疗数据建立的公式可以预测老年髋部骨折患者手术后的低ADL。证据等级：IVb随着人口老龄化和医疗保健的进步，老年人手术的频率正在增加。1、2老年人术后功能下降的频率高于年轻一代。3患者功能下降导致护理人员负担和社会成本增加。4-7此外，一项针对患有严重疾病的老年人的访谈调查报告称，预计将出现严重功能恶化的患者中，约有75%的人即使负担较轻也不想接受治疗。8预防老年人术后功能下降对患者、护理人员和社会都非常重要。
Background:If functional decline after hip surgery can be predicted without special assessment, the effects of new treatments and rehabilitation practices can be easily compared with previous cases or those in other countries. The purpose of this study was to develop and examine a formula for such prediction.Methods:Data of 3,120 patients older than 65 yr with hip fracture were analyzed. The Barthel Index was used for evaluating activities of daily living (ADL). Low ADL was defined as patients with a lower score at discharge than the score at admission and patients with complete dependence at admission that did not change until discharge. Three models were developed in a training sample: Basic, Comorbidity, and Laboratory & Vital Signs models were created by inputting basic patient data, the basic data plus comorbidities, the basic data and comorbidities plus 8 laboratory test results and 5 vital signs, respectively. All potential variables with statistical significance< 0.2 on univariate analyses and some variables that may be clinically meaningful were included in multivariable models. The final model was developed by stepwise logistic regression.Results:The c-statistic of the Laboratory & Vital Signs formula was 0.701 and the predictive value was 76.9%. The c-statistics of the Basic and Comorbidity formulas were 0.643 and 0.664, respectively. Applying the Laboratory & Vital Signs formula to the validation sample, the c-statistic was 0.663.Conclusions:The formula developed from the medical data collected routinely before surgery could predict low ADL following hip fracture surgery in elderly patients.Level of Evidence:IVbWith the aging of the population and advances in medical care, the frequency of surgery for the elderly is increasing. 1, 2 The frequency of postoperative functional decline in the elderly is higher than that in younger generations. 3 Decreased patient function leads to increased caregiver burden and social costs. 4–7 In addition, an interview survey of elderly people suffering from serious illnesses reported that about 75% of patients who are expected to have severe functional deterioration do not want treatment even if the burden is light. 8 Preventing postoperative functional decline in the elderly is very important for patients, caregivers, and society.