AI Article Synopsis

  • Hip fractures in older adults can lead to serious health issues, making risk assessment crucial for care planning and communication with patients and families.
  • The study evaluated and updated the OPERA risk score for hip fracture patients aged 65 and older, comparing it to the Nottingham Hip Fracture Score (NHFS) using 30-day and 1-year mortality rates as key outcomes.
  • The updated score, called Hip-OPERA, showed better predictive ability for mortality and residential status than both the original OPERA and NHFS, highlighting its potential for improved patient management.

Article Abstract

Introduction: Hip fractures are associated with significant morbidity and mortality in older people. Accurate risk stratification is important for planning of care, informed decision-making and communication with patients and relatives. The Older Persons' Emergency Risk Assessment (OPERA) score is a risk stratification score for older people admitted to hospital. Our aims were to validate OPERA in hip fracture patients, update the score and compare performance with the Nottingham Hip Fracture Score (NHFS).

Methods: This dual-centre 3-year observational study (2016-2018) included acutely admitted hip fracture patients managed surgically aged ⩾65 years. The primary outcome was 30-day mortality. Secondary outcomes included residence at 120 days and 1-year mortality. Model performance was assessed using area under the curve (AUC) analysis and Brier scores (discrimination) and calibration curves. The OPERA score was updated using regression analysis with additional independent predictors and validated using bootstrap analysis.

Results: 2142 patients (median age 86 [80-91] years) were included with a 30-day mortality of 5.2% and a 1-year mortality of 31.4%. 30-day mortality AUC for OPERA was 0.75 (95% CI, 0.73-0.77) and for NHFS 0.68 (0.65-0.70). For 1-year mortality AUC for OPERA was 0.74 (0.73-0.75) and for NHFS 0.70 (0.69-0.71). The OPERA Score was updated to Hip-OPERA, including ASA grade. Hip-OPERA demonstrated an AUC for 30-day mortality of 0.77 (0.73-0.81) and an AUC for 1-year mortality of 0.76 (0.75-0.77). AUC for new residential care status at 120 days was 0.79 (0.78-0.80).

Conclusions: Hip-OPERA demonstrated superior discrimination to the NHFS and OPERA for 30-day mortality, 1-year mortality and residence at 120 days following hip fracture. External validation is desirable.

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Source
http://dx.doi.org/10.1177/11207000231154879DOI Listing

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