Development and validation of multivariable prediction models for in-hospital death, 30-day death, and change in residence after hip fracture surgery and the 'stratify-hip' algorithm

Goubar, Aicha; Martin, Finbarr C.; Sackley, Catherine; Foster, Nadine E; Ayis, Salma; Gregson, Celia L.; Cameron, Ian D; Walsh, Nicola E; Sheehan, Katie J.

Abstract

To develop and validate the stratify-hip algorithm (multivariable prediction models to predict those at low, medium, and high risk across in-hospital death, 30-day death, and residence change after hip fracture). Multivariable Fine-Gray and logistic regression of audit data linked to hospital records for older adults surgically-treated for hip fracture in England/Wales 2011-2014 (development n=170,411) and 2015-2016 (external validation, n=90,102). Outcomes included time to in-hospital death, death at 30-days, and time to residence change. Predictors included: age, sex, pre-fracture mobility, dementia, and pre-fracture residence (not for residence change). Model assumptions, performance, and sensitivity to missingness were assessed. Models were incorporated into the stratify-hip algorithm assigning patients to overall low (low risk across outcomes), medium (low death risk, medium/high risk of residence change), or high (high risk of in-hospital death, high/medium risk of 30-day death) risk. For complete-case analysis, 6,780 of 141,158 patients (4.8%) died in-hospital, 8,693 of 149,258 patients (5.8%) died by 30-days, and 4,461 of 119,420 patients (3.7 %) had residence change. Models demonstrated acceptable calibration (observed:expected ratio 0.90, 0.99, and 0.94), and discrimination (area under curve 73.1, 71.1 and 71.5; Brier score 5.7, 5.3, 5.6) for in-hospital death, 30-day death, and residence change, respectively. Overall, 31%, 28%, and 41% of patients were assigned to overall low-, medium-, and high- risk. External validation and missing data analyses elicited similar findings. The algorithm is available at https://stratifyhip.co.uk. The current study developed and validated the stratify-hip algorithm as a new tool to risk stratify patients after hip fracture. [Abstract copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.]

• Journal Article Type: Article
• Acceptance Date: Feb 1, 2023
• Online Publication Date: Feb 9, 2023
• Publication Date: Aug 27, 2023
• Deposit Date: Mar 9, 2023
• Publicly Available Date: Mar 9, 2023
• Journal: The journals of gerontology. Series A, Biological sciences and medical sciences
• Print ISSN: 1079-5006
• Electronic ISSN: 1758-535X
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 78
• Issue: 9
• Pages: 1659-1668
• DOI: https://doi.org/10.1093/gerona/glad053
• Keywords: Stratification, fragility fracture, recovery, classification, fracture neck of femur
• Public URL: https://uwe-repository.worktribe.com/output/10483356
• Publisher URL: https://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/glad053/7031782?login=false