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Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model
OBJECTIVES: The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. METH...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630992/ https://www.ncbi.nlm.nih.gov/pubmed/28947603 http://dx.doi.org/10.1302/2046-3758.69.BJR-2017-0020.R1 |
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author | Tsang, C. Boulton, C. Burgon, V. Johansen, A. Wakeman, R. Cromwell, D. A. |
author_facet | Tsang, C. Boulton, C. Burgon, V. Johansen, A. Wakeman, R. Cromwell, D. A. |
author_sort | Tsang, C. |
collection | PubMed |
description | OBJECTIVES: The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. METHODS: Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models’ coefficients. This was followed by testing the performance of these refined models in a second validation dataset. RESULTS: The 30-day mortality rate was 5.36% in the validation dataset (n = 3861), slightly lower than the 6.40% in the development dataset (n = 4044). The NHFD and Nottingham models showed a slightly lower discrimination in the validation dataset compared with the development dataset, but both still displayed moderate discriminative power (c-statistic for NHFD = 0.71, 95% confidence interval (CI) 0.67 to 0.74; Nottingham model = 0.70, 95% CI 0.68 to 0.75). Both models defined similar ranges of predicted mortality risk (1% to 18%) in assessment of calibration. CONCLUSIONS: Both models have limitations in predicting mortality for individual patients after hip fracture surgery, but the NHFD risk adjustment model performed as well as the widely-used Nottingham prognostic tool and is therefore a reasonable alternative for risk adjustment in the United Kingdom hip fracture population. Cite this article: Bone Joint Res 2017;6:550–556 |
format | Online Article Text |
id | pubmed-5630992 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
record_format | MEDLINE/PubMed |
spelling | pubmed-56309922017-10-13 Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model Tsang, C. Boulton, C. Burgon, V. Johansen, A. Wakeman, R. Cromwell, D. A. Bone Joint Res Hip OBJECTIVES: The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. METHODS: Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models’ coefficients. This was followed by testing the performance of these refined models in a second validation dataset. RESULTS: The 30-day mortality rate was 5.36% in the validation dataset (n = 3861), slightly lower than the 6.40% in the development dataset (n = 4044). The NHFD and Nottingham models showed a slightly lower discrimination in the validation dataset compared with the development dataset, but both still displayed moderate discriminative power (c-statistic for NHFD = 0.71, 95% confidence interval (CI) 0.67 to 0.74; Nottingham model = 0.70, 95% CI 0.68 to 0.75). Both models defined similar ranges of predicted mortality risk (1% to 18%) in assessment of calibration. CONCLUSIONS: Both models have limitations in predicting mortality for individual patients after hip fracture surgery, but the NHFD risk adjustment model performed as well as the widely-used Nottingham prognostic tool and is therefore a reasonable alternative for risk adjustment in the United Kingdom hip fracture population. Cite this article: Bone Joint Res 2017;6:550–556 2017-10-07 /pmc/articles/PMC5630992/ /pubmed/28947603 http://dx.doi.org/10.1302/2046-3758.69.BJR-2017-0020.R1 Text en © 2017 Tsang et al. This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited. |
spellingShingle | Hip Tsang, C. Boulton, C. Burgon, V. Johansen, A. Wakeman, R. Cromwell, D. A. Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model |
title | Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model |
title_full | Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model |
title_fullStr | Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model |
title_full_unstemmed | Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model |
title_short | Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model |
title_sort | predicting 30-day mortality after hip fracture surgery: evaluation of the national hip fracture database case-mix adjustment model |
topic | Hip |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630992/ https://www.ncbi.nlm.nih.gov/pubmed/28947603 http://dx.doi.org/10.1302/2046-3758.69.BJR-2017-0020.R1 |
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