Development and external validation of a preoperative prediction model for in-hospital major adverse cardiovascular events after hip fracture surgery in older adults: a retrospective two-center study.
5 affiliations
- 1Department of Anesthesiology, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan Hospital of Traditional Chinese Medicine, No. 6 Qinren Road, Chancheng District, Foshan, Guangdong, 528000, China.
- 2Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong, 510630, China.
- 3Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong, 510630, China. [email protected].
- 4Institute for Frontier Interdisciplinary Research in Health Sciences and Technology, Sun Yat-sen University, Guangzhou, Guangdong Province, 510275, China. [email protected].
- 5Department of Anesthesiology, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan Hospital of Traditional Chinese Medicine, No. 6 Qinren Road, Chancheng District, Foshan, Guangdong, 528000, China. [email protected].
Abstract
Background
Older adults with hip fracture are vulnerable to postoperative major adverse cardiovascular events (MACE) during hospitalization. However, early risk stratification remains difficult because existing assessments may require complex or late-available information. A simple model based on variables routinely available before surgery may support perioperative decision-making.Methods
We conducted a retrospective two-center cohort study of patients ≥ 60 years who underwent surgery for traumatic hip fracture at 2 hospitals in China. The development cohort included 935 patients treated between January 2024 and December 2025, and the external validation cohort included 168 patients treated between January 2020 and December 2025. Candidate preoperative predictors were screened using penalized regression. Six candidate prediction models were developed and compared using the same preprocessing pipeline. The final model was calibrated using Platt scaling. Model performance was assessed in an internal test set and an external validation cohort.Results
In the development cohort, 122 of 935 patients developed postoperative in-hospital MACE. The final model was a Platt-calibrated logistic regression model including age, baseline electrocardiographic abnormality, chronic heart failure, serum potassium, albumin, and hemoglobin. In the internal test set, the model had an area under the receiver operating characteristic curve of 0.814, with a 95% CI of 0.748-0.876, and a Brier score of 0.102. At the prespecified threshold of 0.147, sensitivity was 0.710 and specificity was 0.754. In the external validation cohort, the area under the receiver operating characteristic curve was 0.760, with a 95% CI of 0.657-0.849. The Brier score was 0.141, sensitivity was 0.788, specificity was 0.630, and negative predictive value was 0.924.Conclusions
A simple preoperative logistic regression model based on routinely available clinical variables showed moderate discrimination in internal testing and provided preliminary external validation evidence for predicting postoperative in-hospital MACE after hip fracture surgery in older adults. The model may support early perioperative risk stratification and postoperative surveillance, although prospective multicenter validation and recalibration are needed before wider clinical use.
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BibTeX
@article{luo2026development,
title = {{Development and external validation of a preoperative prediction model for in-hospital major adverse cardiovascular events after hip fracture surgery in older adults: a retrospective two-center study.}},
author = {Ruimin Luo and Jirong Yang and Jieqiang Du and Siyang Zeng and Tianqiang Sheng and Shuotao Zhong and Chaojin Chen and Yuyuan You},
journal = {BMC geriatrics},
year = {2026},
month = jul,
doi = {10.1186/s12877-026-07981-y},
url = {https://europepmc.org/article/MED/42907950},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Development and external validation of a preoperative prediction model for in-hospital major adverse cardiovascular events after hip fracture surgery in older adults: a retrospective two-center study.
AU - Ruimin Luo
AU - Jirong Yang
AU - Jieqiang Du
AU - Siyang Zeng
AU - Tianqiang Sheng
AU - Shuotao Zhong
AU - Chaojin Chen
AU - Yuyuan You
PY - 2026
DA - 2026/07/01
JO - BMC geriatrics
DO - 10.1186/s12877-026-07981-y
UR - https://europepmc.org/article/MED/42907950
AB - Background Older adults with hip fracture are vulnerable to postoperative major adverse cardiovascular events (MACE) during hospitalization. However, early risk stratification remains difficult because existing assessments may require complex or late-available information. A simple model based on variables routinely available before surgery may support perioperative decision-making.Methods We conducted a retrospective two-center cohort study of patients ≥ 60 years who underwent surgery for traumatic hip fracture at 2 hospitals in China. The development cohort included 935 patients treated between January 2024 and December 2025, and the external validation cohort included 168 patients treated between January 2020 and December 2025. Candidate preoperative predictors were screened using penalized regression. Six candidate prediction models were developed and compared using the same preprocessing pipeline. The final model was calibrated using Platt scaling. Model performance was assessed in an internal test set and an external validation cohort.Results In the development cohort, 122 of 935 patients developed postoperative in-hospital MACE. The final model was a Platt-calibrated logistic regression model including age, baseline electrocardiographic abnormality, chronic heart failure, serum potassium, albumin, and hemoglobin. In the internal test set, the model had an area under the receiver operating characteristic curve of 0.814, with a 95% CI of 0.748-0.876, and a Brier score of 0.102. At the prespecified threshold of 0.147, sensitivity was 0.710 and specificity was 0.754. In the external validation cohort, the area under the receiver operating characteristic curve was 0.760, with a 95% CI of 0.657-0.849. The Brier score was 0.141, sensitivity was 0.788, specificity was 0.630, and negative predictive value was 0.924.Conclusions A simple preoperative logistic regression model based on routinely available clinical variables showed moderate discrimination in internal testing and provided preliminary external validation evidence for predicting postoperative in-hospital MACE after hip fracture surgery in older adults. The model may support early perioperative risk stratification and postoperative surveillance, although prospective multicenter validation and recalibration are needed before wider clinical use.
SN - 1471-2318
ER -