Abstract Title

Preoperative Hip Fracture Patient Risk Stratification Based on Objective Data

Presenter Name

William S. Crawford, MD

Abstract

Hypothesis: Patients with isolated fractures of the proximal femur can be stratified by objective data upon admission with respect to relative risk for post-operative complications.

Materials and Methods: A retrospective analysis of patients with isolated fractures of the proximal femur, taken from the Harris Methodist Hospital hip fracture registry, was evaluated with regards to preoperative objective data (Body Mass Index (BMI), Total Lymphocyte Count, Prealbumin, Albumin, Age, Vitamin D Level, American Society of Anesthesiologists (ASA) score) and the odds ratio of having a post-operative complication based on having abnormalities of these preoperative lab values. Post-operative complications were defined as transfusion, myocardial infarction, cardiac arrest, cerebrovascular accident, arrhythmia, ICU stay, surgical complication, respiratory failure, gastrointestinal complications, bacteremia/sepsis, acute renal failure, pulmonary embolus, pneumonia, deep venous thrombosis, urinary tract infection, and 1 year mortality.

Results: Preliminary statistical analysis demonstrates that patients with a BMI of <18.5 AND prealbumin <18 have a 5x greater risk of post-operative complications. Those with albumin <3.0 AND BMI 25-29.99 have a 4.94x greater risk, those with albumin <3.0 AND vitamin D level 30-80 have a 4.19 greater risk, those with albumin <3.0 AND vitamin D level <30 have a 2.69x greater risk, those with BMI <18.5 AND T-Lymphocyte count <1500 have a 2.42x greater risk. Having age 60-74 AND a BMI of 25-29.99 had a protective effect with an odds ratio of 0.37, and having age 60-75 AND a T-lymphocyte count >1500 also had a protective effect with an odds ratio of 0.36.

Conclusions: Patients can be stratified for risk of post-operative complications based on preoperative nutritional status, as evidenced by the increased odds ratios of low preoperative nutritional labs as well as low BMI levels. There was significant limitation in further evaluating a set if criteria with greater than 2 variables as several patients did not have all laboratory values available preoperatively. This would allow for a prospective study to specifically seek out these variables.

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Preoperative Hip Fracture Patient Risk Stratification Based on Objective Data

Hypothesis: Patients with isolated fractures of the proximal femur can be stratified by objective data upon admission with respect to relative risk for post-operative complications.

Materials and Methods: A retrospective analysis of patients with isolated fractures of the proximal femur, taken from the Harris Methodist Hospital hip fracture registry, was evaluated with regards to preoperative objective data (Body Mass Index (BMI), Total Lymphocyte Count, Prealbumin, Albumin, Age, Vitamin D Level, American Society of Anesthesiologists (ASA) score) and the odds ratio of having a post-operative complication based on having abnormalities of these preoperative lab values. Post-operative complications were defined as transfusion, myocardial infarction, cardiac arrest, cerebrovascular accident, arrhythmia, ICU stay, surgical complication, respiratory failure, gastrointestinal complications, bacteremia/sepsis, acute renal failure, pulmonary embolus, pneumonia, deep venous thrombosis, urinary tract infection, and 1 year mortality.

Results: Preliminary statistical analysis demonstrates that patients with a BMI of <18.5 AND prealbumin <18 have a 5x greater risk of post-operative complications. Those with albumin <3.0 AND BMI 25-29.99 have a 4.94x greater risk, those with albumin <3.0 AND vitamin D level 30-80 have a 4.19 greater risk, those with albumin <3.0 AND vitamin D level <30 have a 2.69x greater risk, those with BMI <18.5 AND T-Lymphocyte count <1500 have a 2.42x greater risk. Having age 60-74 AND a BMI of 25-29.99 had a protective effect with an odds ratio of 0.37, and having age 60-75 AND a T-lymphocyte count >1500 also had a protective effect with an odds ratio of 0.36.

Conclusions: Patients can be stratified for risk of post-operative complications based on preoperative nutritional status, as evidenced by the increased odds ratios of low preoperative nutritional labs as well as low BMI levels. There was significant limitation in further evaluating a set if criteria with greater than 2 variables as several patients did not have all laboratory values available preoperatively. This would allow for a prospective study to specifically seek out these variables.