ACS NSQIP and hip fracture in the elderly. A mini review

Abstract

Introduction: Hip fractures occur commonly in the geriatric population and represent an important source of morbidity and mortality in the elderly population. The increasing incidence of hip fracture in this type of patients is due both to increased life expectancy and to the high prevalence of osteoporosis in the elderly. Hip fracture not only affects the health status of the individual patient, but it is responsible for an increased commitment of resources by the healthcare system. A preoperative tool predicting a potential postoperative complication can help to stratify the risk of each individual patient, to set the best diagnostic and therapeutic procedure. The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons (ACS) has promoted the development of a surgical risk calculation system widespread throughout the world. A surgical risk calculation system was officially created in 2013 and it is available on the web, including twenty different variables such as factors related to the individual patient and the planned surgical procedures. This electronic calculator allows to obtain the percentage of risk of mortality, need for readmission and morbidity, and to estimate the duration of hospitalization.

Methods: We performed a search on the main database such as PubMed and Cochrane Library, using specific terms: i.e. “Hip surgery”, “ACS NSQIP risk calculator”, "proximal femur fracture” and "hip fracture”. We reviewed all the articles relevant to our topic, performing a qualitative analysis of the data presented. Results: We found 107 articles, only four were eligible for a full review. After a careful evaluation, only two studies fitted well with the purpose of our review. These two studies showed a good effectiveness of ACS NSQIP to predict postoperative mortality.

Conclusions: The ACS NSQIP risk calculator seems to be effective in predicting postoperative complications and in particular postoperative mortality after hip surgery, but we do not have enough data. In fact, we have only two studies regarding hip fractures in elderly patients (> 60 years). Further studies are necessary.