The Goldman and Detsky surgical risk indices: Do they work in patients undergoing hip fracture surgery?

The objective of this study was to validate the Goldman and Detsky risk indices in the estimation of cardiac events in high-risk patients undergoing hip-fracture surgery.

The charts of all patients undergoing emergency hip surgery for fracture were reviewed, and the Goldman and Detsky risk scores, and cardiac complications were determined. The predictive performance of the two scores was assessed using receiver operating characteristics (ROC) curve analysis.

Out of the 222 patients, 204 scored 9 or more points on the Goldman Index and 209 scored 15 or more points on the Detsky index. Postoperative cardiac complications occurred in 17 patients, and four died from cardiac causes. The areas under the ROC curve were 0.63 for the Goldman and 0.64 for the Detsky indices (P=0.48). In a multivariate regression analysis, a history of congestive heart failure, aortic stenosis, peripheral vascular disease, diabetes mellitus, and a pre-operative use of angiotensin-converting enzyme inhibitors were independent predictors of cardiac complications.

In this cohort of patients undergoing orthopedic surgery for hip fractures, the Goldman and Detsky indices had modest predictive power for estimating the risk of perioperative cardiac complications. It may be possible to develop better disease-specific risk-stratification models for patients undergoing hip-fracture surgery.