A combined six-factor risk score integrating preoperative and perioperative variables predicted 90-day mortality after geriatric hip fracture with an AUC of 0.737.
Cohort (n=387)
No
Does a combined preoperative and perioperative risk score model accurately predict 90-day mortality in elderly patients undergoing hip fracture surgery?
A combined risk score incorporating preoperative factors and prolonged ICU stay provides acceptable discrimination for predicting 90-day mortality in geriatric hip fracture patients.
Effect estimate: AUC 0.737
Background Hip fractures in the elderly are associated with high 90-day mortality rates. Most existing predictive models rely solely on preoperative variables. This study aimed to develop two parallel risk score models integrating preoperative and perioperative factors to predict 90-day mortality. Methods Medical records of patients aged ≥65 years who underwent hip fracture surgery at our institution between January 2018 and December 2024 were retrospectively reviewed. Five preoperative risk factors were evaluated: Prognostic Nutritional Index 5 days, and intracapsular fracture. The >5-day surgical delay threshold was determined empirically through receiver operating characteristic analysis, as the conventional 48-hour cut-off lacked discriminative capacity in this cohort where 86.8% of patients exceeded it. Model performance was assessed using logistic regression and receiver operating characteristic analysis. Results Of 388 patients enrolled, 387 constituted the analytical sample (60 deaths). The 90-day mortality rate was 15.5%. Individually, each factor showed weak to moderate discrimination. The preoperative five-factor score achieved an AUC of 0.722, and the combined six-factor score — which additionally incorporates ICU stay ≥5 days — achieved an AUC of 0.737. Each unit score increase raised mortality odds approximately 2.68-fold. In patients scoring ≥4, mortality exceeded 50%. The Hosmer-Lemeshow test confirmed adequate calibration for both models. Conclusion A two-stage scoring approach combining admission-available and postoperative variables demonstrated acceptable discrimination and calibration for 90-day mortality prediction in elderly hip fracture patients, supporting its use as a practical risk stratification tool at both preoperative and postoperative clinical decision points.
Erem et al. (2026) conducted a cohort in Geriatric Hip Fracture (n=387). Combined preoperative and perioperative risk score models was evaluated on 90-day mortality (AUC 0.737). A combined six-factor risk score integrating preoperative and perioperative variables predicted 90-day mortality after geriatric hip fracture with an AUC of 0.737.