Nottingham Hip Fracture Score and Acute Physiology and Chronic Health Evaluation-II: Predicting 30-day mortality in elderly hip fracture

BACKGROUND: Hip fractures are a major cause of morbidity and mortality among older individuals. Accurate prediction of 30-day mortality after hip fracture surgery is crucial for effective resource allocation and patient management. AIM: To compare the Nottingham Hip Fracture Score (NHFS) and Acute Physiology and Chronic Health Evaluation (APACHE)-II score in predicting 30-day mortality among 182 geriatric patients (≥ 60 years) undergoing elective hip fracture surgery at Tata Main Hospital, Jamshedpur, India. METHODS: NHFS and APACHE-II scores were calculated preoperatively. Patients were followed up for 30 days post-surgery to determine mortality outcomes. Statistical analysis, including receiver operating characteristic curve analysis, was performed to assess the predictive accuracy of both scores. RESULTS: Results indicated that APACHE-II demonstrated superior predictive ability compared to NHFS. The study also assessed secondary outcomes such as ventilator and inotropic support, acute kidney injury (AKI), cardiac morbidity, pulmonary embolism, deep vein thrombosis, and length of hospital stay (LOS). APACHE-II showed superior performance in predicting the need for ventilator support and AKI. CONCLUSION: Both scores showed significant discrimination for ventilator and inotropic support and LOS but not for AKI. The findings highlight the importance of comprehensive risk stratification for managing geriatric patients with hip fracture.