Predictive value of the pre-injury Barthel index for 1-year postoperative case fatality rate after hip arthroplasty in elderly patients with hip fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHU Jinming ,  LI Xinhua , WENG Xiaobei , SHAO Miao , TENG Jingsi

Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;

Corresponding?author：

LI Xinhua, Email: xinhua936@sina.com

Keywords：

Hip fracture; hip arthroplasty; Barthel index; activities of daily living; case fatality rate

DOI：

10.7507/1002-1892.202604013

Video：

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Objective To explore the predictive value of the pre-injury Barthel index (BI) for 1-year postoperative case fatality rate after hip arthroplasty in elderly patients with hip fracture, and to determine its optimal cut-off value. Methods A retrospective cohort study was conducted. Elderly patients with hip fracture who underwent hip arthroplasty and met the selection criteria between January 1, 2020 and December 31, 2022 were enrolled. General baseline data [age, gender, body mass index (BMI), comorbidities including diabetes and hypertension, medical history including malignancy and thrombosis, and smoking history], clinical indicators (preoperative hemoglobin level, operation duration, postoperative venous thrombosis), pre-admission and pre-injury BI, as well as 1-year postoperative survival outcomes were collected. logistic regression analysis was used to identify risk factors for 1-year postoperative fatality, and receiver operating characteristic curve analysis was performed to determine the optimal cut-off value of pre-injury BI for predicting postoperative fatality. Results A total of 584 patients were enrolled, including 182 males and 402 females, with a mean age of 78.6 years (range, 65-99 years). Sixty-one patients died within 1 year after operation, with a 1-year postoperative case fatality rate of 10.45%. logistic regression analysis showed that age was an independent risk factor for 1-year postoperative fatality (OR=1.138, P=0.002), while pre-injury BI was an independent protective factor (OR=0.972, P=0.008). BMI, preoperative hemoglobin level, and operation duration had no independent predictive significance (P>0.05). The area under the curve of pre-injury BI for predicting 1-year postoperative fatality was 0.794 (95%CI: 0.754, 0.835; P<0.001), with a sensitivity of 0.61, a specificity of 0.98, and the optimal cut-off value of 80. According to the cut-off value, there were 263 patients with pre-injury BI≤80 and 321 patients with pre-injury BI>80. The 1-year postoperative case fatality rates of the two groups were 22.81% and 0.31%, respectively, and the difference was significant (χ²=78.251, P<0.001). Conclusion Pre-injury BI is a reliable predictive factor for 1-year postoperative fatality after hip arthroplasty in elderly patients with hip fracture. It is recommended that pre-injury BI assessment should be included in routine admission evaluation. For patients with pre-injury BI<80, intensified management and multidisciplinary intervention should be implemented to improve postoperative prognosis.

Citation： ZHU Jinming, LI Xinhua, WENG Xiaobei, SHAO Miao, TENG Jingsi. Predictive value of the pre-injury Barthel index for 1-year postoperative case fatality rate after hip arthroplasty in elderly patients with hip fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(8): 1179-1183. doi: 10.7507/1002-1892.202604013 Copy

1.	許鵬, 郭駿飛, 許珂. 老年髖部骨折患者健康狀態評估與手術時機的選擇[J]. 中華創傷骨科雜志, 2024, 26(10): 829-833.
2.	季祥, 孫鳳坡, 劉軍川, 等. 老年人髖部骨折保守治療后一年內死亡的相關危險因素分析[J]. 中華老年醫學雜志, 2021, 40(9): 1160-1164.
3.	余翔, 李波, 楊明輝, 等. 新型診療模式下保守與手術治療老年髖部骨折的中長期療效比較[J]. 中華骨與關節外科雜志, 2021, 14(11): 897-901.
4.	王曉雨, 潘衛宇, 梁瑩, 等. 早期下床活動對人工全髖關節置換術后患者髖關節功能及并發癥的效果[J]. 國際護理學雜志, 2022, 41(2): 287-290.
5.	韓超, 李曉丹, 孫翔, 等. 老年髖部骨折快速手術的研究進展[J]. 中國修復重建外科雜志, 2023, 37(12): 1556-1561.
6.	Nishimura Y, Inagaki Y, Noda T, et al. Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan[J/OL]. Arch Osteoporos, 2023, 18(1): 91. doi: 10.1007/s11657-023-01293-z.
7.	Choi YH, Wong PY, Fong MK, et al. A potential novel predictor of 1-year mortality in elderly hip fracture patients-albumin haemoglobin index[J]. Osteoporos Int, 2025, 36(9): 1557-1564.
8.	鞏楊帆, 陳偉, 謝華澤, 等. 老年髖部骨折患者術后1年死亡的相關因素分析[J]. 中華老年醫學雜志, 2024, 43(10): 1292-1298.
9.	王曉偉, 征華勇, 李紹光, 等. 合并慢性阻塞性肺疾病的老年髖部骨折患者術后1、5年死亡的相關因素分析[J]. 中華創傷骨科雜志, 2022, 24(1): 46-53.
10.	魯攀攀, 謝添, 代廣春, 等. 老年股骨頸骨折患者人工股骨頭置換術后死亡的危險因素分析[J]. 中國修復重建外科雜志, 2021, 35(2): 217-220.
11.	中華醫學會外科學分會, 中華醫學會麻醉學分會. 中國加速康復外科臨床實踐指南(2021)(一)[J]. 協和醫學雜志, 2021, 12(5): 624-631.
12.	Mahoney FI, Barthel DW. Functional evaluation: the Barthel index[J]. Maryland State Medical Journal, 1965, 14: 56-61.
13.	陳麗麗. 前、后循環系統急性腦梗死的預后影響因素及THRIVE、Barthel指數預測價值的臨床研究. 石家莊: 河北醫科大學, 2023.
14.	Katano S, Yano T, Ohori K, et al. Barthel index score predicts mortality in elderly heart failure—A goal of comprehensive cardiac rehabilitation[J]. Circ J, 2021, 86(1): 70-78.
15.	Ryg J, Engberg H, Mariadas P, et al. Barthel Index at hospital admission is associated with mortality in geriatric patients: a Danish nationwide population-based cohort study[J]. Clin Epidemiol, 2018, 10: 1789-1800.
16.	周盈豐, 濮玲菲, 林啟程, 等. 老年髖部骨折手術患者一年死亡率的相關因素分析[J]. 中華醫學雜志, 2021, 101(17): 1269-1274.
17.	高影, 娜日蘇, 李娜, 等. Barthel指數評估老年髖部骨折患者生活自理能力[J]. 武警醫學, 2022, 33(6): 489-492, 496.
18.	張高峰, 喬祺, 許澎, 等. Barthel評分對高齡急性冠狀動脈綜合征患者介入治療預后的評估價值[J]. 中國臨床醫學, 2018, 25(6): 879-883.
19.	蔣云秋, 劉健, 趙丹, 等. rt-PA靜脈溶栓聯合介入治療對急性缺血性腦卒中患者MRS評分、Barthel指數、腦部血流動力學的影響[J]. 臨床和實驗醫學雜志, 2023, 22(15): 1583-1586.
20.	胡雪峰, 余志琴, 倪世君, 等. 老年髖部骨折患者術后1年內死亡的危險因素分析[J]. 中華創傷雜志, 2023, 39(3): 245-251.
21.	芮云峰, 邱曉東, 鄒繼紅, 等. 多學科協作診療模式在老年髖部骨折的臨床應用[J]. 中國修復重建外科雜志, 2019, 33(10): 1276-1282.
22.	謝添, 田楚偉, 芮云峰. 老年髖部骨折加速康復外科的現狀與展望[J]. 中國修復重建外科雜志, 2026, 40(1): 69-74.

1. 許鵬, 郭駿飛, 許珂. 老年髖部骨折患者健康狀態評估與手術時機的選擇[J]. 中華創傷骨科雜志, 2024, 26(10): 829-833.
2. 季祥, 孫鳳坡, 劉軍川, 等. 老年人髖部骨折保守治療后一年內死亡的相關危險因素分析[J]. 中華老年醫學雜志, 2021, 40(9): 1160-1164.
3. 余翔, 李波, 楊明輝, 等. 新型診療模式下保守與手術治療老年髖部骨折的中長期療效比較[J]. 中華骨與關節外科雜志, 2021, 14(11): 897-901.
4. 王曉雨, 潘衛宇, 梁瑩, 等. 早期下床活動對人工全髖關節置換術后患者髖關節功能及并發癥的效果[J]. 國際護理學雜志, 2022, 41(2): 287-290.
5. 韓超, 李曉丹, 孫翔, 等. 老年髖部骨折快速手術的研究進展[J]. 中國修復重建外科雜志, 2023, 37(12): 1556-1561.
6. Nishimura Y, Inagaki Y, Noda T, et al. Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan[J/OL]. Arch Osteoporos, 2023, 18(1): 91. doi: 10.1007/s11657-023-01293-z.
7. Choi YH, Wong PY, Fong MK, et al. A potential novel predictor of 1-year mortality in elderly hip fracture patients-albumin haemoglobin index[J]. Osteoporos Int, 2025, 36(9): 1557-1564.
8. 鞏楊帆, 陳偉, 謝華澤, 等. 老年髖部骨折患者術后1年死亡的相關因素分析[J]. 中華老年醫學雜志, 2024, 43(10): 1292-1298.
9. 王曉偉, 征華勇, 李紹光, 等. 合并慢性阻塞性肺疾病的老年髖部骨折患者術后1、5年死亡的相關因素分析[J]. 中華創傷骨科雜志, 2022, 24(1): 46-53.
10. 魯攀攀, 謝添, 代廣春, 等. 老年股骨頸骨折患者人工股骨頭置換術后死亡的危險因素分析[J]. 中國修復重建外科雜志, 2021, 35(2): 217-220.
11. 中華醫學會外科學分會, 中華醫學會麻醉學分會. 中國加速康復外科臨床實踐指南(2021)(一)[J]. 協和醫學雜志, 2021, 12(5): 624-631.
12. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index[J]. Maryland State Medical Journal, 1965, 14: 56-61.
13. 陳麗麗. 前、后循環系統急性腦梗死的預后影響因素及THRIVE、Barthel指數預測價值的臨床研究. 石家莊: 河北醫科大學, 2023.
14. Katano S, Yano T, Ohori K, et al. Barthel index score predicts mortality in elderly heart failure—A goal of comprehensive cardiac rehabilitation[J]. Circ J, 2021, 86(1): 70-78.
15. Ryg J, Engberg H, Mariadas P, et al. Barthel Index at hospital admission is associated with mortality in geriatric patients: a Danish nationwide population-based cohort study[J]. Clin Epidemiol, 2018, 10: 1789-1800.
16. 周盈豐, 濮玲菲, 林啟程, 等. 老年髖部骨折手術患者一年死亡率的相關因素分析[J]. 中華醫學雜志, 2021, 101(17): 1269-1274.
17. 高影, 娜日蘇, 李娜, 等. Barthel指數評估老年髖部骨折患者生活自理能力[J]. 武警醫學, 2022, 33(6): 489-492, 496.
18. 張高峰, 喬祺, 許澎, 等. Barthel評分對高齡急性冠狀動脈綜合征患者介入治療預后的評估價值[J]. 中國臨床醫學, 2018, 25(6): 879-883.
19. 蔣云秋, 劉健, 趙丹, 等. rt-PA靜脈溶栓聯合介入治療對急性缺血性腦卒中患者MRS評分、Barthel指數、腦部血流動力學的影響[J]. 臨床和實驗醫學雜志, 2023, 22(15): 1583-1586.
20. 胡雪峰, 余志琴, 倪世君, 等. 老年髖部骨折患者術后1年內死亡的危險因素分析[J]. 中華創傷雜志, 2023, 39(3): 245-251.
21. 芮云峰, 邱曉東, 鄒繼紅, 等. 多學科協作診療模式在老年髖部骨折的臨床應用[J]. 中國修復重建外科雜志, 2019, 33(10): 1276-1282.
22. 謝添, 田楚偉, 芮云峰. 老年髖部骨折加速康復外科的現狀與展望[J]. 中國修復重建外科雜志, 2026, 40(1): 69-74.

Chinese Journal of Reparative and Reconstructive Surgery

Predictive value of the pre-injury Barthel index for 1-year postoperative case fatality rate after hip arthroplasty in elderly patients with hip fracture

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