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Dementia is a surrogate for frailty in hip fracture mortality prediction
Örebro University, School of Medical Sciences. Department of Orthopedics Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-3583-3443
Örebro University, School of Medical Sciences. Department of Orthopedics Surgery, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Medical Sciences. Department of Orthopedics Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-3436-1026
Örebro University, School of Medical Sciences. Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, PA, USA.ORCID iD: 0000-0002-1918-9443
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2022 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 48, no 5, p. 4157-4167Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Among hip fracture patients both dementia and frailty are particularly prevalent. The aim of the current study was to determine if dementia functions as a surrogate for frailty, or if it confers additional information as a comorbidity when predicting postoperative mortality after a hip fracture.

METHODS: All adult patients who suffered a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017 were considered for inclusion. Pathological fractures, non-operatively treated fractures, reoperations, and patients missing data were excluded. Logistic regression (LR) models were fitted, one including and one excluding measurements of frailty, with postoperative mortality as the response variable. The primary outcome of interest was 30-day postoperative mortality. The relative importance for all variables was determined using the permutation importance. New LR models were constructed using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models.

RESULTS: 121,305 patients were included in the study. Initially, dementia was among the top ten most important variables for predicting 30-day mortality. When measurements of frailty were included, dementia was replaced in relative importance by the ability to walk alone outdoors and institutionalization. There was no significant difference in the predictive ability of the models fitted using the top ten most important variables when comparing those that included [AUC for 30-day mortality (95% CI): 0.82 (0.81-0.82)] and excluded [AUC for 30-day mortality (95% CI): 0.81 (0.80-0.81)] measurements of frailty.

CONCLUSION: Dementia functions as a surrogate for frailty when predicting mortality up to one year after hip fracture surgery. The presence of dementia in a patient without frailty does not appreciably contribute to the prediction of postoperative mortality.

Place, publisher, year, edition, pages
Springer, 2022. Vol. 48, no 5, p. 4157-4167
Keywords [en]
Dementia, Frailty, Hip fracture, Logistic regression, Mortality prediction, Permutation importance
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-98420DOI: 10.1007/s00068-022-01960-9ISI: 000775823600001PubMedID: 35355091Scopus ID: 2-s2.0-85127398898OAI: oai:DiVA.org:oru-98420DiVA, id: diva2:1648779
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Funding agency:

Örebro University

Available from: 2022-04-01 Created: 2022-04-01 Last updated: 2024-03-06Bibliographically approved

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Forssten, Maximilian PeterIoannidis, IoannisMohammad Ismail, AhmadBass, Gary AlanBorg, TomasCao, YangMohseni, Shahin

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Forssten, Maximilian PeterIoannidis, IoannisMohammad Ismail, AhmadBass, Gary AlanBorg, TomasCao, YangMohseni, Shahin
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European Journal of Trauma and Emergency Surgery
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