Keywords
Stroke
Risk prediction model
Submitted : 2026-06-07
Accepted : 2026-06-22
Published : 2026-07-07
Abstract
Objective: To construct a nomogram prediction model for the risk of stroke in patients with hip fractures during the perioperative period. Methods: The clinical data of patients with hip fracture surgery admitted to a Class III Grade A hospital from January 2019 to December 2023 were selected (n = 895). According to the presence or absence of perioperative stroke, the patients were divided into the case group (n = 53) and the control group (n = 842). Univariate and multivariate analyses were used to analyze the risk factors of stroke in patients, and a prediction model was constructed. A nomogram was drawn to visualize the logistic regression prediction model, and the ROC curve and decision curve were used to analyze the prediction efficiency of the logistic regression model. Results: Age ≥60 years, BMI ≥24 kg/m2, history of hypertension, history of diabetes, history of stroke, general anesthesia, abnormal intraoperative blood pressure, and operation time were included in the final prediction model. The AUC of the validation set was 0.955 (95% CI: 0.923–0.986). The calibration curve showed that the predicted probability fitted the actual incidence well (Hosmer-Lemeshow test P = 0.005), and DCA confirmed that the model had a net clinical benefit. Conclusion: The risk prediction model constructed in this study can effectively identify patients with a high risk of perioperative stroke after hip fracture surgery, and has good prediction efficiency and clinical practicability, which is convenient for early and accurate prediction of perioperative stroke risk.
References
Jing W, Jing J, Pan Y, et al., 2023, Research Progress on Prevention of Perioperative Ischemic Stroke in Elderly Patients with Fracture. Chin J Orthopedics, 31(14): 1299–1303.
Chen C, Rui Y, Yang Y, et al., 2012, The Role of Intensive Care Unit in Enhanced Recovery After Surgery for Hip Fractures in the Elderly. Practical Geriatrics, 36(11): 1085–1087.
Zhou Q, Tian M, Zhang X, et al., 2012, A Meta-Analysis of Risk Factors for Stroke in Patients with Hip Fracture. Evidence-Based Nursing, 8(18): 2425–2431.
Bian Y, Xie Q, Li M, 2012, Clinical Research Progress of Perioperative Stroke. Infection, Inflammation and Repair, 23(01): 52–56.
Huo X, Zhang C, Zhang W, 2024, Treatment of Acute Ischemic Stroke with Endovascular Mechanical Thrombectomy in Perioperative Period of Cardiac Surgery. Chin J Modern Neurodis, 24(11): 865–868.
Chinese Committee for Revision of Guidelines for the Prevention and Treatment of Hypertension, Hypertension Alliance (China), Hypertension Branch of Chinese International Exchange and Promotion Association for Medical and Healthcare, et al., 2024, Chinese Guidelines for the Prevention and Treatment of Hypertension (2024 Revision), Chin J Hypertension (Chinese and English), 32(07): 603–700.
Zhang X, Feng Q, 2020, Construction and Validation of Risk Factors Nomogram for Prognosis of Elderly Stroke Patients with Hip Fracture. Chinese Journal of Emergency Medicine, 45(6): 476–481.
Chinese Stroke Association, Neurointervention Branch of Chinese Stroke Association, Intervention Group of Stroke Prevention and Control Committee of Chinese Preventive Medicine Association, 2023, Chinese Guidelines for Endovascular Treatment of Acute Ischemic Stroke in 2023. Chinese Journal of Stroke, 18(6): 684–711.
Zhang J, Wang L, Wu Y, 2020, Perioperative Treatment and Rehabilitation Progress of Pelvic Fractures. Medical Review, 26(12): 2371–2375.
Du L, Ma Y, Zhao H, et al., 2024, Establishment and Validation of Risk Factors Prediction Model for Hip Fracture in Elderly Stroke Patients. Chinese Tissue Engineering Research, 28(36): 5793–5798.
Bao L, Chai R, 2023, Incidence and Risk Factors of Postoperative Delirium and Cerebrovascular Accident in Elderly Patients with Hip Fracture. Modern Diagnosis and Therapy, 34(01): 115–117.
Wang H, Gao L, 2021, Association between General Anesthesia and the Occurrence of Cerebrovascular Accidents in Hip Fracture Patients. J Healthc Eng, 2021: 7271136.
Luo Z, Min S, 2016, Anesthesia Physiology, 4th Ed., People’s Medical Publishing House, Beijing, 1.
Chen Y, Zhao J, Guo X, et al., 2021, Risk Factors for the First Hip Fracture in Elderly Women. Chin J Gerontology, 41(13): 2750–2753.
Liu J, Zhao Y, Zhu M, 2012, Meta-Analysis of Risk Factors for Postoperative Delirium in Elderly Patients with Hip Fracture. Clinical Research of Traditional Chinese Medicine, 14(09): 111–115.
Li A, Sheng M, 2025, Research Progress on Prognostic Assessment Methods for Diabetic Kidney Disease. Journal of Sun Yat-sen University (Medical Sciences), 46(01): 50–60.
Tanovic E, Selimovic S, Tanovic H, 2014, Assessment of the Effects of Rehabilitation After Cerebrovascular Accident in Patients with Diabetes Mellitus and Hypertension as Risk Factors. Med Arch, 68(2): 124–127.
Gorgui J, Gorshkov M, Khan N, et al., 2014, Hypertension as a Risk Factor for Ischemic Stroke in Women. Can J Cardiol, 30(7): 774–782.
Wang W, 2000, Research Progress on Epidemiology of Stroke, Proceedings of the Seventh National Training Class and Academic Conference on Prevention, Treatment and Rehabilitation of Cerebrovascular Disease, National Cerebrovascular Disease Prevention and Treatment Research Office of China Rehabilitation Medicine, Xi’an, 1–9.
Yu L, Zhu Y, Chen W, et al., 2020, Incidence and Risk Factors Associated with Postoperative Stroke in the Elderly Patients Undergoing Hip Fracture Surgery. Journal of Orthopaedic Surgery and Research, 15: 1–7.
Aizereti Ali Mai Mai Ti, Liu S Chen, Li J, et al., 2021, Risk Factors for Postoperative Neurological Dysfunction in Patients with Acute Stanford Type A Aortic Dissection. Journal of Cardio-Pulmonary Vasculopathy, 43(06): 610–617.
Wu J, Xu D, 2012, Evaluation and Management of Perioperative Hypertension in Non-Cardiac Surgery. J Clin Med, 39(01): 8–10.
Yao R, Wu H, Hu W, et al., 2015, Risk Factors for Perioperative Stroke in Elderly Patients with Hip Fracture. Journal of Baotou Medical College, 31(6): 39–40.
Ni G, Lu Q, 2007, Risk Factors for Postoperative Cerebrovascular Disease in Elderly Patients with Hip Fracture. Chin J Med, (01): 58–60.
Alloubani A, Nimer R, Samara R, 2021, Relationship between Hyperlipidemia, Cardiovascular Disease and Stroke: A Systematic Review. Curr Cardiol Rev, 17(6): e051121189015.
Zhang H, 2020, Risk Factors for Postoperative Cerebrovascular Accident in Elderly Patients with Hip Fracture. International J Nursing, 39(24): 4468–4472.