MO480: Predictive Ability of Clinical Assessment Tools For &gt;2 Weeks in-Hospital Stay Following Hip Fracture in Patients Living With CKD: Insights From a 7-Year Prospective Analysis
Authors: Lin Henry Wu Hon , Van Mierlo Reinier , Mclauchlan George , Challen Kirsty , Dhaygude Ajay , Mitra Sandip , Nixon Andrew 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Individuals living with chronic kidney disease (CKD) are at greater risk of sustaining hip fractures compared with the general population. Following acute trauma, CKD patients are susceptible to lengthened hospitalization with their clinical condition exacerbated by frailty, co-morbidities and sarcopaenia. The most useful clinical assessment tools to predict lengthened in-hospital stays in patients with CKD following admission with hip fracture remain unestablished.

METHOD
Patients with CKD G3b-5 admitted from home to a tertiary centre hospital in North West UK with hip fracture between Jun 2013 and Jun 2020 were evaluated. Lengthened hospitalization is determined by &gt;2 weeks of in-hospital stay in our analysis, given the average length of in-hospital stay is ∼14 days for the CKD population following hip fracture. Clinical assessment tools used in admission assessment for each patient included the Clinical Frailty Scale (CFS), Charlson's Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Karnofsky's Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, Estimated VO2 Peak, ASA Physical Status Classification System Score and the Abbreviated Mental Test Score. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual clinical assessment tools to predict for &gt;2 weeks of in-hospital stay in patients with CKD admitted following hip fracture.

RESULTS
A total of 539 patients with CKDG3b-5 were admitted following hip fracture throughout the study period, of which 329 patients had &gt;2 weeks of in-hospital stay. Within the cohort with &gt;2 weeks of in-hospital stay, mean age was 84.4 ± 10.6 years. The female: male ratio was 1.6:1. Of those, 47 patients (14.3%) were on long-term dialysis. For this cohort, 30-day, 6-month and 1-year mortality were 6.7%, 14.9% and 43.2%, respectively. The odds ratio (OR) for 30-day {OR: 1.71, [95% confidence interval (95% CI) 1.04–2.39]; P &lt; .01}, 6-month (OR: 2.06, 95% CI 1.38–2.73; P &lt; .01) and 1-year mortality (OR: 2.62, 95% CI 1.95–3.30; P &lt; .01) was significantly higher in CKD patients with &gt; 2 weeks of in-hospital stay following hip fracture compared with those who were discharged within the first 2 weeks of hospitalization. Area Under the Curve (AUC) values from ROC analyses for individual clinical assessment tools are shown in Table 1.

CONCLUSION
Frailty and co-morbidity clinical assessment tools (CFS, CCI and CKD FI-LAB) displayed the best predictive ability for lengthened in-hospital stays in patients living with CKD admitted following hip fracture. CKD patients with lengthened in-hospital stays following hip fracture have greater risks of acute in-hospital mortality and mortality over the short- to medium-term following discharge. Research initiatives should continue to evaluate multidisciplinary management strategies for the older CKD population following acute trauma. Reducing the length of hospitalization may improve survival outcomes and alleviate costs and public health burdens in the care of the older CKD population.