Combination Of Charlson’s Weighted Index Of Comorbidities And Modified POSSUM Scoring System In Prognosis Evaluation Of Intertrochanteric Fracture In Elder Patients

ObjectiveTO predict the surgery risk of intertrochanteric fracture in elder patients by combination of Charlson’s weighted index of comorbidities and modified POSSUM scoring system and to investigate the value of the combination of the two scoring systems. To assess the effction of medical diseases, preoperative physiological state, surgical invasion in the prognosis.MethodsThe clinical data of intertrochanteric fracture patients aged≥60 years old in the Trauma Orthopedic Department of First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2013 to January 2015 were analyzed retrospectively. The patients were divided into complication group and non-complication group according to hospitalization outcomes. The data were recorded including age, sex, diagnosis of fracture, medical diseases, preoperative hemoglobin levels, albumin levels, blood urea nitrogen values, white blood cell count, ECG results, timing of surgery, anesthesia measures, species of internal fixation, operative time, surgical blood loss, occurring postoperative complications or death or not. Charlson’s weighted index of comorbidities(CCI score), modified POSSUM physiological score were calculated before operation and operative severity score was calculated after operation. Multivariate logistic regression analysis was used to determine the independent predictors for postoperative complications. And a receiver operating characteristic curve (ROC) was used to compare the value of CCI score and modified POSSUM physiological score on predicting prognosis of patients.Results131 cases of intertrochanteric fractures in elderly patients were enrolled in this study,male 46 cases (35.1%), female 85 cases (64.9%), mean age:80.01 ±7.26 years old, patients with significant medical diseases before operation 111 cases (84.73%). The postoperative complications occurred in 38 cases(29.01%), during hospitalization, including three deaths (2.29%),93 cases (70.99%) had no complications. Between the two groups, univariate analysis showed that P values of age, preoperative hemoglobin levels, albumin levels, blood urea nitrogen values, ECG results, modified POSSUM physiology score, CCI score, anesthesia measures, surgical blood loss and operative severity score were all less than 0.2. The above 10 variables were put into the multivariate logistic regression model. The analysis showed that preoperative hemoglobin levels, albumin levels, blood urea nitrogen values, ECG results, anesthesia measures, surgical blood loss, modified POSSUM physiology score, CCI score were independently correlated to the prognosis during hospitalization (P<0.05). ROC curve showed that modified POSSUM physiology score, CCI score and the two combined to predict the probability of the area under the curve [AUC (95% CI)] were 0.657 (0.624～0.690),0.649 (0.615～0.683),0.668 (0.636～0.700).ConclusionTO assess the operative risk and prognosis of intertrochanteric fractures in elderly patients, combining application of modified POSSUM scoring system and CCI score is better than any kind of scoring system using alone. Preoperative hemoglobin levels, albumin levels, blood urea nitrogen values, ECG results, anesthesia measures, surgical blood loss, modified POSSUM physiology score, CCI score were independent factors to the prognosis during hospitalization.