Machine learning-based prediction of short- and long-term mortality for shared decision-making in older hip fracture patients: the Dutch Hip Fracture Audit algorithms in 74,396 cases

Acta Orthopaedica, vol. 96, pp. 521–528

Abstract

BACKGROUND AND PURPOSE: Treatment-related shared decision-making (SDM) in older adults with hip fractures is complex due to the need to balance patient-specific factors such as life goals, frailty, and surgical risks. It includes considerations such as prognosis and decisions concerning whether to operate or not on frail, life-limited patients. We aimed to develop machine learning (ML)-driven prediction models for short- and long-term mortality in a large cohort of patients with hip fractures. METHODS: In this national registry-based retrospective cohort study, patients aged ≥ 70 years registered in the nationwide Dutch Hip Fracture Audit from 2018-2023 were included. Predictive variables were selected based on the literature and/or clinical relevance. 6 ML algorithms, including logistic regression, were trained with internal cross-validation and evaluated on discrimination (c-statistic), sensitivity, specificity, calibration, and interpretability. RESULTS: 74,396 patients (median age 84, IQR 78-89; 68% female) were analyzed. Most patients lived at home (69%) and high malnutrition risk was seen in 10%. 18% had dementia. Mortality rates were 9.1% (30-day), 15% (90-day), and 26% (1-year). Logistic regression performed comparably to other algorithms, but was chosen as the preferred algorithm due to its superior interpretability (c-statistic: 30-day 0.82, 90-day 0.81, 1-year 0.80). CONCLUSION: We developed and validated ML algorithms, including logistic regression, for mortality prediction in older hip fracture patients with adequate performance. This information may inform SDM.

Authors 7

1. Hidde Dijkstra

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen; University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands hiddedijkstra95@gmail.com

   University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

2. Hanne-Eva van Bremen Aachen Dutch Institute for Clinical Auditing

   Amsterdam UMC Location University of Amsterdam · Dutch Institute for Clinical Auditing · Amsterdam University Medical Centers · Amsterdam Movement Sciences · University of Amsterdam

   Affiliation as printed

   Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam; Dutch Institute for Clinical Auditing, Leiden; Amsterdam University Medical Centers, location Academic Medical Center, Internal Medicine and Geriatrics, University of Amsterdam, Amsterdam, The Netherlands

   Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam

   Amsterdam University Medical Centers, location Academic Medical Center, Internal Medicine and Geriatrics, University of Amsterdam, Amsterdam, The Netherlands

   Dutch Institute for Clinical Auditing, Leiden

3. Hanna C. Willems

   Amsterdam UMC Location University of Amsterdam · Amsterdam Public Health · Amsterdam University Medical Centers · Amsterdam Movement Sciences · University of Amsterdam

   Affiliation as printed

   Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam; Amsterdam University Medical Centers, location Academic Medical Center, Internal Medicine and Geriatrics, University of Amsterdam, Amsterdam; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

   Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam

   Amsterdam University Medical Centers, location Academic Medical Center, Internal Medicine and Geriatrics, University of Amsterdam, Amsterdam

4. Anne de Hond

   University Medical Center Utrecht

   Affiliation as printed

   Julius Centre for Health Sciences and Primary Care, University Medical Center, Utrecht; the Netherlands

   Julius Centre for Health Sciences and Primary Care, University Medical Center, Utrecht

   the Netherlands

5. Barbara C. Van Munster

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

6. Job Nicolaas Doornberg

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands

7. Jacobien H. F. Oosterhoff

   University Medical Center Groningen · University of Groningen · Delft University of Technology

   Affiliation as printed

   Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen; Department of Engineering Systems & Services, Faculty of Technology Policy and Management, Delft University of Technology, Delft, The Netherlands

   Department of Engineering Systems & Services, Faculty of Technology Policy and Management, Delft University of Technology, Delft, The Netherlands

   Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen