Key result
CARES score predicts 2-year mortality better than ASA-PS and comparably to D-CCI.
Why the study?
Risk stratification tools are important for identifying high-risk hip fracture patients, but comparative data on CARES, ASA-PS, and D-CCI for predicting 2-year mortality are needed.
Does the CARES score predict 2-year mortality after hip fracture surgery better than ASA-PS and D-CCI in surgically treated hip fracture patients?
Observational (n=763)
No
Does the CARES score predict 2-year mortality after hip fracture surgery better than ASA-PS and D-CCI in surgically treated hip fracture patients?
The CARES score is a viable and simpler risk predictor for 2-year mortality following hip fracture surgery, comparable in predictive capability to the D-CCI.
CARES predicts 2-year post-hip fracture mortality comparably to D-CCI and better than ASA-PS; leaves open whether it improves risk stratification in prospective practice.
Background: The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo–Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. Methods and Material: A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015. Age, gender, time to surgery, ASA-PS score, D-CCI, and CARES score were obtained. Univariate and multivariable logistic regression analyses were used to assess statistical significance of scores and risk factors, and area under the receiver operating characteristic (ROC) curve (AUC) was used to compare ASA-PS, D-CCI, and CARES as predictors of mortality at 2 years. Results: 763 surgically treated hip fracture patients were included in this study. The 2-year mortality rate was 13.1% (n = 100), and the mean ± SD CARES score of surviving and demised patients was 21.2 ± 5.98 and 25.9 ± 5.59, respectively. Using AUC, CARES was shown to be a better predictor of 2-year mortality than ASA-PS, but we found no statistical difference between CARES and D-CCI. A CARES score of 23, attributable primarily to pre-surgical morbidities and poor health of the patient, was identified as the statistical threshold for “high” risk of 2-year mortality. Conclusion: The CARES score is a viable risk predictor for 2-year mortality following hip fracture surgery and is comparable to the D-CCI in predictive capability. Our results support the use of a simpler yet clinically relevant CARES in prognosticating mortality following hip fracture surgery, particularly when information on the pre-existing comorbidities of the patient is not immediately available.
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Cher et al. (2021) conducted an observational in hip fracture (n=763). CARES score vs. ASA-PS score and D-CCI was evaluated on 2-year mortality. The CARES score predicted 2-year mortality (overall rate 13.1%) better than ASA-PS and comparably to D-CCI, with mean scores of 25.9 in demised versus 21.2 in surviving patients.
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