Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year mortality

Germán Garabano; Cesar Angel Pesciallo; Leonel Perez Alamino; Glenda Ernst; Hernan Del Sel

doi:10.1016/j.jcot.2021.101743

Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year mortality

J Clin Orthop Trauma. 2021 Dec 17:25:101743. doi: 10.1016/j.jcot.2021.101743. eCollection 2022 Feb.

Authors

Germán Garabano¹, Cesar Angel Pesciallo¹, Leonel Perez Alamino¹, Glenda Ernst², Hernan Del Sel¹

Affiliations

¹ Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina.
² Scientific Advisory Committee, British Hospital of Buenos Aires, Buenos Aires, Argentina.

Abstract

Background: Hip fractures have a significant impact on morbidity and mortality in the elderly. Aims: We retrospectively evaluated the predictive role of the Charlson Comorbidity Index (CCI) for 1-year mortality in elderly patients with unstable intertrochanteric hip fractures (ITHF) treated with bipolar hemiarthroplasty. The secondary objective was to identify other relationships, if any, between the variables recorded and mortality.

Methods: We included ≥75-year-old patients with unstable ITHF treated with bipolar hemiarthroplasty. We recorded patient gender, age, Body Mass Index, pre-fracture walking ability (Parker Mobility score, modified Harris Hip Score), America Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), time to surgery, time to mobilization, hospital stay, and postoperative complications. Uni- and multivariate logistic regression analysis were performed. Sensitivity and specificity were calculated using a ROC curve.

Results: A total of 135 patients with a mean age of 87.34 ± 5.5 years were included. The overall 1-year mortality rate was 18.5%. The CCI (OR 1.64 CI 95% 1.21-2.23; p 0.00821) and postoperative complications (OR 3.5 CI 95% 1.19-10.23 p 0.0202) were identified as independent predictors of 1-year mortality in the univariate regression and confirmed in the multivariate regression. CCI sensitivity to predict 1-year mortality was 80%.

Conclusion: CCI has shown acceptable sensitivity in the prediction of 1-year mortality in elderly patients with unstable ITHF treated with bipolar hemiarthroplasty. It is of utmost importance to prevent postoperative complications due to their significant impact on 1-year mortality.

Keywords: 1-Year mortality; Bipolar hemiarthroplasty; Charlson comorbidity index; Unstable intertrochanteric fractures.