Clinics in orthopedic surgery · 2026
Development and Validation of a Perioperative Risk Update Model for Postoperative Delirium in Patients Aged ≥ 80 Years Undergoing Hip Fracture Surgery: A Retrospective Cohort Study.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Zhao Feifei, Sai Huan, Peng Shan, Wu Jing, Wang Lingling, Zhang Tao, Zhang Xuebin
Аннотация
BACKGROUND: Postoperative delirium (POD) remains a frequent and serious complication after hip fracture surgery in very old patients. A clinically usable risk model could facilitate perioperative risk updating and targeted prevention in this vulnerable population.
METHODS: We retrospectively included consecutive patients aged ≥ 80 years undergoing hip fracture surgery between January 2021 and December 2023 (n = 666). POD during hospitalization was the primary outcome. Candidate predictors covering demographics, comorbidities, perioperative variables, and routine laboratory tests were prespecified. Predictors were selected using least absolute shrinkage and selection operator with 10-fold cross-validation and entered into multivariable logistic regression to develop a nomogram. Discrimination, calibration, and clinical utility were assessed. External validation was conducted in an institutionally related cohort (January 2024 to December 2025) using identical eligibility criteria. Two sensitivity analyses were conducted to assess the robustness.
RESULTS: POD occurred in 99 patients (14.9%). The final nomogram included 14 predictors and showed excellent discrimination in the derivation cohort, with an area under the receiver operating characteristic curve (AUC) of 0.913 (95% CI, 0.877-0.948). At the optimal predicted-probability threshold of 0.274, the sensitivity and specificity were 0.788 and 0.922, respectively. Bootstrap calibration demonstrated close agreement between predicted and observed risks, with a bias-corrected mean absolute error of 0.009. In the external validation cohort, the model retained good discrimination, with an AUC of 0.884. In addition, the preoperative-only sensitivity model also retained good predictive performance.
CONCLUSIONS: This nomogram provides individualized perioperative POD risk estimation for octogenarian patients undergoing hip fracture surgery. Additionally, clinically meaningful risk estimation may also be feasible before surgery.
METHODS: We retrospectively included consecutive patients aged ≥ 80 years undergoing hip fracture surgery between January 2021 and December 2023 (n = 666). POD during hospitalization was the primary outcome. Candidate predictors covering demographics, comorbidities, perioperative variables, and routine laboratory tests were prespecified. Predictors were selected using least absolute shrinkage and selection operator with 10-fold cross-validation and entered into multivariable logistic regression to develop a nomogram. Discrimination, calibration, and clinical utility were assessed. External validation was conducted in an institutionally related cohort (January 2024 to December 2025) using identical eligibility criteria. Two sensitivity analyses were conducted to assess the robustness.
RESULTS: POD occurred in 99 patients (14.9%). The final nomogram included 14 predictors and showed excellent discrimination in the derivation cohort, with an area under the receiver operating characteristic curve (AUC) of 0.913 (95% CI, 0.877-0.948). At the optimal predicted-probability threshold of 0.274, the sensitivity and specificity were 0.788 and 0.922, respectively. Bootstrap calibration demonstrated close agreement between predicted and observed risks, with a bias-corrected mean absolute error of 0.009. In the external validation cohort, the model retained good discrimination, with an AUC of 0.884. In addition, the preoperative-only sensitivity model also retained good predictive performance.
CONCLUSIONS: This nomogram provides individualized perioperative POD risk estimation for octogenarian patients undergoing hip fracture surgery. Additionally, clinically meaningful risk estimation may also be feasible before surgery.