Validation of the Charlson Comorbidity Index for the prediction of 30-day and 1-year mortality among patients who underwent hip fracture surgery

Eveline de Haan; Benthe van Oosten; Veronique A J I M van Rijckevorsel; T Martijn Kuijper; Louis de Jong; Gert R Roukema

doi:10.1186/s13741-024-00417-4

Validation of the Charlson Comorbidity Index for the prediction of 30-day and 1-year mortality among patients who underwent hip fracture surgery

Perioper Med (Lond). 2024 Jul 3;13(1):67. doi: 10.1186/s13741-024-00417-4.

Authors

Eveline de Haan^{1

2}, Benthe van Oosten³, Veronique A J I M van Rijckevorsel³, T Martijn Kuijper⁴, Louis de Jong^#³, Gert R Roukema^#³

Affiliations

¹ Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands. e.eveline.de.haan@gmail.com.
² Surgery Department, Franciscus Hospital, Rotterdam, 3045 PM, the Netherlands. e.eveline.de.haan@gmail.com.
³ Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands.
⁴ Maasstad Academy, Maasstad Hospital, Rotterdam, 3079 DZ, the Netherlands.

^# Contributed equally.

Abstract

Introduction: The aim of our study was to validate the original Charlson Comorbidity Index (1987) (CCI) and adjusted CCI (2011) as a prediction model for 30-day and 1-year mortality after hip fracture surgery. The secondary aim of this study was to verify each variable of the CCI as a factor associated with 30-day and 1-year mortality.

Methods: A prospective database of two-level II trauma teaching hospitals in the Netherlands was used. The original CCI from 1987 and the adjusted CCI were calculated based on medical history. To validate the original CCI and the adjusted CCI, the CCI was plotted against the observed 30-day and 1-year mortality, and the area under the curve (AUC) was calculated.

Results: A total of 3523 patients were included in this cohort study. The mean of the original CCI in this cohort was 5.1 (SD ± 2.0) and 4.6 (SD ± 1.9) for the adjusted CCI. The AUCs of the prediction models were 0.674 and 0.696 for 30-day mortality for the original and adjusted CCIs, respectively. The AUCs for 1-year mortality were 0.705 and 0.717 for the original and adjusted CCIs, respectively.

Conclusions: A higher original and adjusted CCI is associated with a higher mortality rate. The AUC was relatively low for 30-day and 1-year mortality for both the original and adjusted CCIs compared to other prediction models for hip fracture patients in our cohort. The CCI is not recommended for the prediction of 30-day and 1-year mortality in hip fracture patients.