title: Admission Norton scale scores (ANSS) and postoperative complications following hip fracture surgery in the elderly.
abstract: We sought to determine if low ANSS, usually associated with high pressure ulcer risk, are also associated with postoperative complications and in-hospital mortality following hip fracture surgery in the elderly. This was a retrospective cross-sectional study conducted in a tertiary medical center. The medical charts of consecutive elderly (≥ 65 years) patients admitted for hip fracture surgery were studied for the following measurements: ANSS, demographic data, co-morbidities, postoperative complications, the need for revision procedures, and in-hospital mortality. Except for pressure ulcers, postoperative complications included: acute coronary syndrome, acute renal failure, confusion, pneumonia, urinary tract infection, venous thromboembolism, and wound infection. The final cohort included 269 patients: 198 (73.6%) females and 71 (26.4%) males. Mean age for the entire cohort was 82.8 ± 0.4 years. Most patients underwent an internal fixation (n=146; 54.3%) or hemiarthroplasty (n=92; 34.2%). Overall, 110 (40.9%) patients had low (<15) ANSS. Patients with low ANSS had significantly more postoperative complications relative to patients with high ANSS (0.77 ± 0.09 vs. 0.23 ± 0.04; p<0.0001). Among all postoperative complications, urinary tract infection was independently associated with low ANSS (p<0.0001). ANSS were independently associated with postoperative complications (p<0.0001), the need for revision procedures (p=0.019), and in-hospital mortality (p=0.016). We conclude that the Norton scoring system may be used for predicting postoperative complications and in-hospital mortality following hip fracture surgery in the elderly.
authors.affiliation: Division of Orthopedic Surgery, Sourasky Medical Center, 6 Weitzman street, Tel-Aviv 64239, Israel.
authors.forename: Aviram
authors.initials: A
authors.lastname: Gold
authors.forename: Ronen
authors.initials: R
authors.lastname: Sever
authors.forename: Yaffa
authors.initials: Y
authors.lastname: Lerman
authors.forename: Moshe
authors.initials: M
authors.lastname: Salai
authors.forename: Dan
authors.initials: D
authors.lastname: Justo
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000209:etiology; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D003221:Confusion / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects* / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010343:Patient Admission; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology; D014946:Wound Infection / Q000453:epidemiology / Q000209:etiology