umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The modified Sernbo score as a predictor of 1-year mortality after hip fracture: A registry study on 55,716 patients
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
Show others and affiliations
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose

Patients sustaining a hip fracture have a high mortality rate during the first postoperative year and the Sernbo score may stratify patients into a high, intermediate and low risk of death during this period. We added gender with the aim to improve the original score (i.e. a modified score), and assessed its predictive properties on patients from the National Swedish Hip Fracture Register.

Patients and Methods

55,716 hip fracture patients, 69% women, older than 65 years at surgery (registered between 2010-2015) with complete Sernbo scores and mortality data were studied. Receiver Operating Characteristics analyses (ROC) were used. Validation of Sernbo score.

Results

The over-all 1-year mortality rate was 26% - and 6%, 17% and 42% in the low, intermediate and high risk groups respectively. The ROC analysis indicated a predictive ability of the Modified-Sernbo score, with an AUC of 0.72 (CI 0.71–0.73). ROC analysis of the original Sernbo Score showed an AUC 0.70 (CI 95% 0.70-0.71).

Conclusion

The Modified-Sernbo score identifies patients at high-risk of death during the first year postoperatively, slight improvement when adding sex to the score and validated on national level. This scoring system could be used to tailor peri- and postoperative care and treatment in patients with hip fracture.

National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:umu:diva-163443OAI: oai:DiVA.org:umu-163443DiVA, id: diva2:1352784
Available from: 2019-09-19 Created: 2019-09-19 Last updated: 2019-09-19
In thesis
1. Studies on the complications and prediction of mortality after hip fracture surgery
Open this publication in new window or tab >>Studies on the complications and prediction of mortality after hip fracture surgery
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

An elderly patient who sustains a hip fracture has increased morbidity and mortality. Scandinavia presents the highest incidence annually of hip fractures worldwide. 

Femoral neck fracture (FNF) of the hip accounts for 50% of all hip fractures in geriatric patients. Intertrochanteric and subtrochanteric femoral fracture accounts for the other 50%. Hip fracture patients are plagued with a high 1-year mortality rate ranging from 8% to 36%. Complications of hip fracture surgery after arthroplasty generally include periprosthetic fracture (PPF), periprosthetic joint infection (PJI), and dislocation. 

Treatent regarding FNF has improved in the last decade. Arthroplasties are currently the standard treatment for displaced FNFs in the elderly. The surgical treatment of PPF can be technically demanding, with a high frequency of complications due to deep infection, dislocation and intraoperative fractures. Some prosthetic designs have been reported.

PJIs are associated with prolonged antibiotic treatment, multiple revision surgeries, prolonged hospital stays, late aseptic loosening and poor functional outcome for the patients. A widely accepted treatment of choice for acute deep PJIs comprises debridement, antibiotics and implant retention (DAIR).

There are currently several models for predicting mortality with the aim of identifying and optimizing patients at risk. The Sernbo score was initially developed as a guidance tool for the orthopedic surgeon in decision making in hip fracture surgery.

Study I: This was a prospective cohort study of patients with FNFs treated with hemiarthroplasty or total arthroplasty. The aim of this study was to compare the risk for PPF between the straight, highly, polished, tapered (CPT) stem and the matte anatomic SPII stem. It was found that the CPT stem imposed a higher risk of postoperative PPF.

Study II: This was a retrospective multicenter cohort study of patients with FNFs treated with total or hemiarthroplasty. The aim of this study was to compare the risk for PPF between the straight, highly polished, tapered Exeter stem and the matte anatomic SPII stem. It was found that Exeter stem imposed a higher risk of sustaining a PPF.

Study III: This was a retrospective cohort study of patients treated with a primary hip arthroplasty (hemi- or total hip) for a displaced FNF. The primary aim of this study was to identify the frequency of PJI and to evaluate the success rate of DAIR. The secondary aim was to analyze the risk factors for developing PJI. It was found that DAIR had a high short- term success rate and that the need for repeated bandage changes indicates an increased risk of PJI and should prompt early surgical intervention.

Study IV: This was a retrospective study with the aim of validating the Sernbo score for predicting mortality after hip replacement for a displaced FNF in elderly patients. The Sernbo score (based on age, habitat, walking aids and mental state) can be used to stratify patients into groups with different one-year mortality rates. The score can be calculated using information obtained during routine orthopedic patient assessments.The Sernbo score was found to identify patients at high risk of dying in the first postoperative year.

Study V: This was a retrospective registry study. All patients who sustained a hip fracture and registered in “Rikshöft” (a Swedish database for hip fracture) were included. The aim of this study was to validate the Sernbo score for predicting mortality after hip fracture in elderly patients on a registry-based level. It was found that the Sernbo score can be used to stratify patients into groups with different one-year mortality rates.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2019
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2049
Keywords
Hip fracture, femoral neck fracture, treatment, total hip arthroplasty, hemiarthroplasty, internal fixation, outcome, infection, periprosthetic joint infection, mortality
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-163442 (URN)978-91-7855-101-9 (ISBN)
Public defence
2019-10-11, Sal B, Tandläkarhögskolan, 9 tr, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-09-20 Created: 2019-09-19 Last updated: 2019-09-19Bibliographically approved

Open Access in DiVA

No full text in DiVA

Authority records BETA

Mellner, CarlMukka, Sebastian

Search in DiVA

By author/editor
Mellner, CarlMukka, Sebastian
By organisation
Department of Surgical and Perioperative Sciences
Orthopaedics

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 15 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf