Performance of the Nottingham hip fracture score (NHFS) as a predictor of 30-day mortality after proximal femur fracture in an older people Brazilian cohort

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Ferro, Flavio Cruz ; Campos, Marcos Adriano Garcia ; Picolli, Thais Caroline Silva ; Mayoral, Vania de Sa ; Soares, Victoria Moralez ; Ferreira, Jessica Caroline ; Peres, Lucas Dias Borges ; Tibeau, Theodor Terra Mayer ; Bernardi, Victor El Chihimi ; Pereira, David Nascimento ; Gumieiro, David Nicoletti ; Curcelli, Emilio Carlos ; Navarro e Lima, Lais Helena ; do Nascimento Junior, Paulo ; Lazzarin, Taline ; Ballarin, Raquel Simoes ; Okoshi, Marina Politi ; Minicucci, Marcos Ferreira ; de Paiva, Sergio Alberto Rupp ; Gordon, Adam Lee ; Sahota, Opinder ; Pereira, Filipe Welson Leal ; Azevedo, Paula Schmidt

• Document type: Journal article
• Source: SCIENTIFIC REPORTS; v. 15, n. 1, p. 12-pg., 2025-02-15.

Abstract

Perioperative risk assessment helps inform clinical practice for older people with hip fractures. This is a cohort study, where perioperative risk screening, including NHFS, was performed at admission, followed by an evaluation of 30-day outcomes. 503 patients were included, 73% female, 79.4 +/- 9.3 years old; 58% presented extracapsular and 42% intracapsular fractures, with a 30-day mortality of 9%. The NHFS was higher in the patients who died at 5.6 +/- 1.1 compared to survivals at 4.3 +/- 1.5 (p-value < 0.001). NHFS > 4 was associated with 30-day mortality observed by Cox regression adjusted by fracture type: HR 4.55 (95% CI 2.10-9.82) (p-value < 0.001) and Kaplan-Meyer Curve (HR 3.94; 95% CI 2.19-7.07; p-value < 0.001). ROC curve showed the accuracy of NHFS in explaining 30-day mortality (AUC 0.74; 95% CI 0.67-0.81). Complications were higher among patients with NHFS > 4. The performance of NHFS was better than the traditional perioperative risk ASA score. Therefore, NHFS can be implemented in real-world clinical practice to estimate the 30-day mortality risk for hip fracture in older patients in Brazil. NHFS > 4 is critical for 30-day mortality and complications; this cutoff helps inform clinical practice. The present study might motivate other centers to consider NHFS in their perioperative risk assessment routine. (AU)

• FAPESP's process: 22/15147-6 - Association of biomarkers and muscle ultrasound with Sarcopenia and frailty syndrome in the acute and subacute hip fracture in the older people and its association with clinical outcomes
• Grantee: Paula Schmidt Azevedo Gaiolla
• Support Opportunities: Regular Research Grants
• FAPESP's process: 23/00225-4 - Association between severity of peripheral arterial disease and conditions related to muscle mass and function in patients with atherosclerosis
• Grantee: David do Nascimento Pereira
• Support Opportunities: Scholarships in Brazil - Scientific Initiation