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\begin{document}


\def\RunningAuthor{Rahul Sharma et al.}
\firstPage{1119}
\articleType{Original Article}
\receivedDate{06 Feb 2021}
\acceptedDate{12 Mar 2021}
\revisedDate{09 Mar 2021}
\journalVolume{2021, 12}
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\journalDoi{ijrps.v12i2.4643}
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\title{Prediction score to assess morbidity/mortality of patient after fracture proximal 1/3\ensuremath{^{rd}} femur}
\author{Ravindra~B.~Gunaki,  
            Rahul~Sharma\textsuperscript{*},  
            Chitresh~Mehta,  
            Swapnil~Chitnavis, 
            Vibhu~Pratap~Singh~\\[5pt]{Department of Orthopaedics, Krishna Institute of Medical Sciences, Karad, Maharashtra, India}}

\begin{abstract}
Fractures around the hip joint in the elderly is a major health concern with respect to perioperative and post operative morbidity, especially in the 1-year postoperative period. The prospective and retrospective study was carried out at Krishna Institute of Medical Sciences, Karad, over a period of 1 year. Various comorbidities play a detrimental role in the postoperative outcome of these fractures. 100 patients of the gediatric age group with fracture around the hip joint were studied and followed for about a year to assess 1-year morbidity. An attempt is made to categorize all the comorbidities and create a Comorbidity Index. The Predictors included in the Comorbidity Index are age, pre-fracture mobility, anaemia, gender, diabetes mellitus, hypertension, ischemic heart disease, renal disease, dementia, alcohol dependence, tobacco chewing, serum protein levels, previous surgeries, stroke, antiplatelet drug intake, duration between operation and death and cause of death. The outcome of the Comorbidity Index determines the deceased patients had an average of 13.73 Comorbidity Index Score, whereas the non-deceased patients had an average of 4.95 Comorbidity Index Score. This score can also be helpful in providing counselling to the patient and the patient's relative  about the patient's outcome for surgery. This score will also prove useful in reducing medico-legal complications and will be documented and explained to the patient's relatives.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Fracture,\newline Hip joint,\newline Comorbidities,\newline pre-fracture mobility
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Rahul~Sharma~\\ Phone:\ +919466756987~\\  Email:\ rahulsharma9466756987@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
The fractures around the hip in elderly patients is a major public health concern. The age group the fracture affects mainly also increases perioperative and postoperative morbidity, mortality, loss of independence, and financial burden.

 The most crucial phase being the first year after the operation. Studies have shown that 1-year mortality in the wake of supporting a hip break has been assessed to be 15\%. The overall danger of mortality in the old patient population increments 4\% each year.

The regular post-operative follow up of operative Hip Fracture Patients required a holistic approach for patient care. The patient's general condition and other comorbidities play a vital role in the recovery of the patient. 

A detailed survey in these patients helped us to understand the postoperative mortality related factors. An attempt is made to compile all the data we have achieved. The aim of the study is to study the effect of various comorbidities in patients with hip fracture.
    
\section{Methods}
The prospective and retrospective study was carried out at Krishna Institute of Medical Sciences, Karad, from July 1 2018, and March 1, 2020. This program was standardized, redesigned, and expanded to include 100 geriatric patients with various comorbidities who sustained a hip fracture. Patients with hip fractures were admitted through the casualty department, OPD or directly from other institutions. All patients admitted under the orthopedic department were screened under the routine protocol. When the patient was medically fit, the patient was posted for surgery. Throughout the hospital stay, orthopaedic surgeons shared ``responsibility'' of the patients' orthopaedic complaints as well as other comorbidities.

\textbf{Inclusion Criteria}


  
  \begin{enumerate}
  \item \relax Patients 50 years of age or older
  \item \relax Proximal femur fracture 
  \item \relax Patient willing to take part in a study
  \end{enumerate}
  \textbf{Exclusion Criteria }


  
  \begin{enumerate}
  \item \relax Pathological fracture
  \item \relax Periprosthetic fracture
  \item \relax Previous hip fracture treated or treated nonoperatively.
  \end{enumerate}
  The Predictors included in the Comorbidity Index are age, pre-fracture mobility, anaemia, gender, diabetes mellitus, hypertension, ischemic heart disease, renal disease, dementia, alcohol dependence, tobacco chewing, serum protein levels, previous surgeries, stroke, antiplatelet drug intake, duration between operation and death and cause of death.
    
\section{Results and Discussion}
In our study, conducted at our hospital, among the study population of 100, 15 mortalities were noted in the prospective postoperative period, which was termed Group A. The remaining 85 patients were assigned to Group B.

In our study, people belonging to the 50-70 years age group were 5 (33.33\%) among Group A and 41 (48.23\%) among Group B. People belonging to age group {\textgreater} 70 years were 10 (66.67\%) among Group A and 44(51.76\%) among Group B, Table~\ref{tw-10d01a664b8f}


\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to age group} }
\label{tw-10d01a664b8f}
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\begin{tabulary}{\linewidth}{p{\dimexpr.185\linewidth-2\tabcolsep}p{\dimexpr.215\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.1834\linewidth-2\tabcolsep}p{\dimexpr.2166\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Age group & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack \textless\ 50 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\cAlignHack 50-70 &
  \cAlignHack 5 &
  \cAlignHack 33.33 &
  \cAlignHack 41 &
  \cAlignHack 48.23\\
\cAlignHack {\textgreater}70 &
  \cAlignHack 10 &
  \cAlignHack 66.67 &
  \cAlignHack 44 &
  \cAlignHack 51.76\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Pre Fracture Mobility} }
\label{tw-20c36e94ca2e}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2748\linewidth-2\tabcolsep}p{\dimexpr.15010000000000002\linewidth-2\tabcolsep}p{\dimexpr.1967\linewidth-2\tabcolsep}p{\dimexpr.1784\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Pre Fracture Mobility & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Yes &
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  \cAlignHack 100 &
  \cAlignHack 85 &
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\cAlignHack No &
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  \cAlignHack 0 &
  \cAlignHack 0 &
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\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence of Anaemia} }
\label{tw-37c286b37abf}
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\centering 
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\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Anaemia & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Yes &
  \cAlignHack 13 &
  \cAlignHack 86.67 &
  \cAlignHack 5 &
  \cAlignHack 6.25\\
\cAlignHack No &
  \cAlignHack 2 &
  \cAlignHack 13.33 &
  \cAlignHack 80 &
  \cAlignHack 93.75\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence of Diabetes Mellitus} }
\label{tw-6448dce4fb7e}
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\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.23490000000000002\linewidth-2\tabcolsep}p{\dimexpr.17669999999999998\linewidth-2\tabcolsep}p{\dimexpr.1884\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Diabetes Mellitus & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Absent &
  \cAlignHack 6 &
  \cAlignHack 40 &
  \cAlignHack 77 &
  \cAlignHack 90.58\\
\cAlignHack {\textless}5 &
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  \cAlignHack 8 &
  \cAlignHack 9.42\\
\cAlignHack 5-10 &
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  \cAlignHack 33.33 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\cAlignHack {\textgreater}10 &
  \cAlignHack 3 &
  \cAlignHack 20 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence of Hypertension} }
\label{tw-142dbea04cce}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack HTN & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Absent &
  \cAlignHack 8 &
  \cAlignHack 53.33 &
  \cAlignHack 73 &
  \cAlignHack 85.88\\
\cAlignHack {\textless}5 &
  \cAlignHack 4 &
  \cAlignHack 26.67 &
  \cAlignHack 12 &
  \cAlignHack 14.11\\
\cAlignHack 5-10 &
  \cAlignHack 3 &
  \cAlignHack 20 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\cAlignHack {\textgreater}10 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence of Ischemic Heart Disease} }
\label{tw-fc43fd31c977}
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\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack IHD & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack No &
  \cAlignHack 12 &
  \cAlignHack 80 &
  \cAlignHack 85 &
  \cAlignHack 100\\
\cAlignHack Yes &
  \cAlignHack 2 &
  \cAlignHack 13.33 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\cAlignHack CABG &
  \cAlignHack 1 &
  \cAlignHack 6.67 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence of Stroke} }
\label{tw-1c3e592a43ba}
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\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2149\linewidth-2\tabcolsep}p{\dimexpr.1685\linewidth-2\tabcolsep}p{\dimexpr.2166\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Stroke & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack No &
  \cAlignHack 13 &
  \cAlignHack 86.67 &
  \cAlignHack 80 &
  \cAlignHack 94.11\\
\cAlignHack Yes &
  \cAlignHack 1 &
  \cAlignHack 6.67 &
  \cAlignHack 5 &
  \cAlignHack 5.89\\
\cAlignHack Stroke with paralysis &
  \cAlignHack 1 &
  \cAlignHack 6.67 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to History of Antiplatelet Drug intake} }
\label{tw-30cefa50a7de}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.28139999999999997\linewidth-2\tabcolsep}p{\dimexpr.18510000000000005\linewidth-2\tabcolsep}p{\dimexpr.1717\linewidth-2\tabcolsep}p{\dimexpr.1734\linewidth-2\tabcolsep}p{\dimexpr.1884\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Antiplatelet Drug & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Yes &
  \cAlignHack 6 &
  \cAlignHack 40 &
  \cAlignHack 5 &
  \cAlignHack 5.89\\
\cAlignHack No &
  \cAlignHack 9 &
  \cAlignHack 60 &
  \cAlignHack 80 &
  \cAlignHack 84.11\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence of Renal Disease} }
\label{tw-00c846ce7a8b}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.308\linewidth-2\tabcolsep}p{\dimexpr.18169999999999998\linewidth-2\tabcolsep}p{\dimexpr.18339999999999996\linewidth-2\tabcolsep}p{\dimexpr.15180000000000003\linewidth-2\tabcolsep}p{\dimexpr.17509999999999998\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Renal Disease & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack No &
  \cAlignHack 1 &
  \cAlignHack 6.67 &
  \cAlignHack 68 &
  \cAlignHack 80\\
\cAlignHack Slightly elevated Urea Creatinine Level &
  \cAlignHack 10 &
  \cAlignHack 66.67 &
  \cAlignHack 12 &
  \cAlignHack 14.11\\
\cAlignHack Moderately Elevated Urea Creatinine Level &
  \cAlignHack 4 &
  \cAlignHack 26.67 &
  \cAlignHack 5 &
  \cAlignHack 5.89\\
\cAlignHack Dialysis &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence of Dementia} }
\label{tw-298dc531a5a0}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1834\linewidth-2\tabcolsep}p{\dimexpr.2166\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Dementia & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Yes &
  \cAlignHack 1 &
  \cAlignHack 6.67 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\cAlignHack No &
  \cAlignHack 14 &
  \cAlignHack 93.33 &
  \cAlignHack 85 &
  \cAlignHack 100\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to the Presence of Alcohol Dependence} }
\label{tw-1789b19812e8}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.31300000000000004\linewidth-2\tabcolsep}p{\dimexpr.15679999999999996\linewidth-2\tabcolsep}p{\dimexpr.1784\linewidth-2\tabcolsep}p{\dimexpr.17509999999999998\linewidth-2\tabcolsep}p{\dimexpr.1767\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Alcohol Dependence & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Yes &
  \cAlignHack 4 &
  \cAlignHack 26.67 &
  \cAlignHack 5 &
  \cAlignHack 5.89\\
\cAlignHack No &
  \cAlignHack 11 &
  \cAlignHack 73.33 &
  \cAlignHack 80 &
  \cAlignHack 94.11\\
\cAlignHack Psychiatric treatment for /withdrawal &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence of Tobacco Chewing with Peptic Ulcer Disease} }
\label{tw-0400953d5067}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2333\linewidth-2\tabcolsep}p{\dimexpr.1783\linewidth-2\tabcolsep}p{\dimexpr.1884\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Tobacco Chewing & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Yes &
  \cAlignHack 3 &
  \cAlignHack 20 &
  \cAlignHack 12 &
  \cAlignHack 14.11\\
\cAlignHack No &
  \cAlignHack 12 &
  \cAlignHack 80 &
  \cAlignHack 73 &
  \cAlignHack 85.89\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Presence Serum protein Level} }
\label{tw-b6facfb52579}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.26810000000000002\linewidth-2\tabcolsep}p{\dimexpr.18509999999999998\linewidth-2\tabcolsep}p{\dimexpr.1833\linewidth-2\tabcolsep}p{\dimexpr.1635\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Serum Protein Level & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack 6-8.3 g/dl &
  \cAlignHack 3 &
  \cAlignHack 20 &
  \cAlignHack 80 &
  \cAlignHack 94.11\\
\cAlignHack 5-6 g/dl &
  \cAlignHack 10 &
  \cAlignHack 66.67 &
  \cAlignHack 5 &
  \cAlignHack 5.89\\
\cAlignHack {\textless}5 g/dl &
  \cAlignHack 2 &
  \cAlignHack 13.33 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to History of Previous Surgeries} }
\label{tw-7c63902e4669}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.25650000000000006\linewidth-2\tabcolsep}p{\dimexpr.18669999999999995\linewidth-2\tabcolsep}p{\dimexpr.1834\linewidth-2\tabcolsep}p{\dimexpr.18169999999999998\linewidth-2\tabcolsep}p{\dimexpr.1917\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack H/O Previous Surgeries & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Yes &
  \cAlignHack 6 &
  \cAlignHack 40 &
  \cAlignHack 5 &
  \cAlignHack 5.89\\
\cAlignHack No &
  \cAlignHack 9 &
  \cAlignHack 60 &
  \cAlignHack 80 &
  \cAlignHack 94.11\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Duration between operation and death} }
\label{tw-1fb156e1b574}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3093\linewidth-2\tabcolsep}p{\dimexpr.332\linewidth-2\tabcolsep}p{\dimexpr.3587\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Duration & \cAlignHack Group A & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack {\textgreater}6 months &
  \cAlignHack 13 &
  \cAlignHack 86.67\\
\cAlignHack 3-6 months &
  \cAlignHack 2 &
  \cAlignHack 13.33\\
\cAlignHack 0-3 months &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to the Liver Function Test (Total Bilirubin)} }
\label{tw-15332ed88ef0}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.26820000000000004\linewidth-2\tabcolsep}p{\dimexpr.18329999999999995\linewidth-2\tabcolsep}p{\dimexpr.18340000000000003\linewidth-2\tabcolsep}p{\dimexpr.185\linewidth-2\tabcolsep}p{\dimexpr.1801\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack LFT (Total Bilirubin) & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack 0.3-1 mg/dL &
  \cAlignHack 3 &
  \cAlignHack 20 &
  \cAlignHack 63 &
  \cAlignHack 74.11\\
\cAlignHack 1-1.5 mg/dL &
  \cAlignHack 8 &
  \cAlignHack 53.33 &
  \cAlignHack 17 &
  \cAlignHack 20\\
\cAlignHack {\textgreater}1.5 mg/dL &
  \cAlignHack 4 &
  \cAlignHack 26.67 &
  \cAlignHack 5 &
  \cAlignHack 5.89\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to History of Peripheral Vascular Disease} }
\label{tw-87cd753c612a}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1834\linewidth-2\tabcolsep}p{\dimexpr.2166\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack H/O PVD & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack Yes &
  \cAlignHack 6 &
  \cAlignHack 40 &
  \cAlignHack 12 &
  \cAlignHack 14.11\\
\cAlignHack No &
  \cAlignHack 9 &
  \cAlignHack 60 &
  \cAlignHack 73 &
  \cAlignHack 85.89\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of study population according to Ejection Fraction \%} }
\label{tw-06845434f1d7}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.185\linewidth-2\tabcolsep}p{\dimexpr.1735\linewidth-2\tabcolsep}p{\dimexpr.2415\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack EF\% & \cAlignHack Group A & \cAlignHack Percentage & \cAlignHack Group B & \cAlignHack Percentage\\
\tblmidrule 
\cAlignHack {\textgreater}60 &
  \cAlignHack 5 &
  \cAlignHack 33.33 &
  \cAlignHack 68 &
  \cAlignHack 80\\
\cAlignHack 55-60 &
  \cAlignHack 3 &
  \cAlignHack 20 &
  \cAlignHack 17 &
  \cAlignHack 20\\
\cAlignHack {\textless}55 &
  \cAlignHack 7 &
  \cAlignHack 46.67 &
  \cAlignHack 0 &
  \cAlignHack 0\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Comorbidity Predictor Table} }
\label{tw-bf82b19fe43c}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.25979999999999997\linewidth-2\tabcolsep}p{\dimexpr.17172000000000004\linewidth-2\tabcolsep}p{\dimexpr.19668000000000003\linewidth-2\tabcolsep}p{\dimexpr.2416\linewidth-2\tabcolsep}p{\dimexpr.13020000000000001\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack  & \cAlignHack 0 & \cAlignHack 1 & \cAlignHack 2 & \cAlignHack 3\\
\tblmidrule 
\cAlignHack Age &
  \cAlignHack - &
  \cAlignHack {\textless}50 &
  \cAlignHack 50-70 &
  \cAlignHack {\textgreater}70\\
\cAlignHack Prefracture Mobility &
  \cAlignHack Yes &
  \cAlignHack No &
  \cAlignHack - &
  \cAlignHack -\\
\cAlignHack Anemia &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack - &
  \cAlignHack -\\
\cAlignHack Diabetes Mellitus &
  \cAlignHack Absent &
  \cAlignHack {\textless}5 Years &
  \cAlignHack 5-10 Years &
  \cAlignHack {\textgreater}10 Years\\
\cAlignHack Hypertension &
  \cAlignHack Absent &
  \cAlignHack {\textless}5  &
  \cAlignHack 5-10 Years &
  \cAlignHack {\textgreater}10 Years\\
\cAlignHack Ischemic Heart Disease &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack H/O CABG &
  \cAlignHack -\\
\cAlignHack Stroke &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack Stroke with Paralysis &
  \cAlignHack -\\
\cAlignHack H/O Antiplatelet Drugs &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack - &
  \cAlignHack -\\
\cAlignHack Renal Disease &
  \cAlignHack Normal &
  \cAlignHack Slightly Elevated &
  \cAlignHack Moderately Elevated &
  \cAlignHack Dialysis\\
\cAlignHack Dementia &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack - &
  \cAlignHack -\\
\cAlignHack Alcohol Dependence &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack Psychiatric Treatment for Withdrawal &
  \cAlignHack -\\
\cAlignHack Tobacco Chewing with Peptic Ulcer &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack - &
  \cAlignHack -\\
\cAlignHack Serum Protein Level &
  \cAlignHack 6-8.3 g\% &
  \cAlignHack 5-6 g\% &
  \cAlignHack {\textless}5 g\% &
  \cAlignHack -\\
\cAlignHack H/O Previous Surgery &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack - &
  \cAlignHack -\\
\cAlignHack LFT Total Bilirubin (mg/dL) &
  \cAlignHack 0.3-1 &
  \cAlignHack 1-1.5 &
  \cAlignHack {\textgreater}1.5 &
  \cAlignHack -\\
\cAlignHack PVD &
  \cAlignHack No &
  \cAlignHack Yes &
  \cAlignHack - &
  \cAlignHack -\\
\cAlignHack EF\% &
  \cAlignHack {\textgreater}60 &
  \cAlignHack 50-60 &
  \cAlignHack {\textless}50 &
  \cAlignHack -\\
\cAlignHack ASA &
  \cAlignHack 1,2 (Normal Cardiac finding) &
  \cAlignHack 2 (Abnormal Cardiac Finding) &
  \cAlignHack 3 &
  \cAlignHack 4\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
In our study, 100\% of the study population in both Group A, as well as Group B, had Pre Fracture Mobility, Table~\ref{tw-20c36e94ca2e}.

In our study, 86.67\% of patients were anaemic in Group A, while only 6.25\% of patients were anaemic in Group B, Table~\ref{tw-37c286b37abf}

In our study, among Group A6.67\% of patients suffering from Diabetes Mellitus for less than 5 years, 33.33\% patients suffered from Diabetes Mellitus for 5-10 years, and 20\% patients suffered from Diabetes Mellitus for greater than 10 years. While in Group B, 90.58\% of patients were not diagnosed with Diabetes Mellitus and 9.42\% of patients suffering from Diabetes Mellitus for less than 5 years, Table~\ref{tw-6448dce4fb7e}. 

In our study, among Group A, 26.67 \% of patients suffered from Hypertension for less than five years, 20\% of patients suffered from Hypertension for 5-10 years. While in Group B, 85.88\% of patients were not diagnosed with Hypertension and 14.11\% of patients suffered from Hypertension for less than 5 years, Table~\ref{tw-142dbea04cce}.

In our study, among Group A, 13.33\% of patients had a history of Ischemic Heart Disease and 6.67\% of patients  had a history of CABG, Table~\ref{tw-fc43fd31c977}. 

In our study, in Group A, 6.67\% of patients had a history of stroke and 6.67\% of patients had a history of stroke with paralysis. While in Group B, 5.89 \% of patients had a history of stroke, in Table~\ref{tw-1c3e592a43ba}. 

In our study, 40\% of patients were on Antiplatelet Drugs in Group A, while 5.89\% of patients were on Antiplatelet Drugs in Group B, in Table~\ref{tw-30cefa50a7de}. 

In our study, slight elevation of urea and creatinine levels were seen in 66.67\% of patients in Group A and in 14.11\% of patients in Group B. Moderate elevation of urea and creatinine levels were seen in 26.67\% in Group A and in 5.89\% in Group B, Table~\ref{tw-00c846ce7a8b}.

In our study, 6.67\% of patients among Group A had a history of Dementia, Table~\ref{tw-298dc531a5a0}.

In our study, 26.67\% of patients in Group A and 5.89\% of patients in Group B had a history of Alcohol Dependence, in Table~\ref{tw-1789b19812e8}.

In our study, 20\% of patients in Group A and 14.11\% of patients in Group B had a history of Tobacco Chewing, Table~\ref{tw-0400953d5067}.

In our study, among Group A, 20\% of patients had normal serum protein levels, 66.67\% patients had serum protein levels in the range of 5-6 g/dl, and 13.33\% patients had the level \textless\ 5 g/dl. While in Group B, 94.11\% of patients had normal serum protein level, and 5.89\% of patients had serum protein levels in the range of 5-6 g/dl, Table~\ref{tw-b6facfb52579}.

In our study, 40\% of patients from Group A and 5.89\% of patients from Group B had a history of Previous Surgeries, Table~\ref{tw-7c63902e4669}.

In our study, 86.67\% of patients had {\textgreater}6 months duration between operation and death, and 13.33\% of patients had 3-6 months duration between operation and death, Table~\ref{tw-1fb156e1b574}.

In our study, 53.33\% of patients had Total Bilirubin levels of 1 to 1.5 mg/dL in Group A and 74.11\% of patients in Group B had Total Bilirubin levels of 0.3 to 1 mg/dL, Table~\ref{tw-15332ed88ef0}.

In our study, 40\% of patients in Group A and 14.11\% of patients in Group B had a History of Peripheral Vascular Disease, Table~\ref{tw-87cd753c612a}. 

In our study, among Group A, 33.33\% patients had EF\% {\textgreater}60\%, 20\% patients had EF\% in the range of 55-60\%, and 46.67\% patients had EF\% {\textless}55\%. In Group B, 80\% patients had EF\%

{\textgreater}60\%, 20\% patients had EF\% in range of 55-60\%, and 0\% patients had EF\% {\textless}55\%, Table~\ref{tw-06845434f1d7}. 

In our study, among Group A, 26.67\% of patients had an ASA score of 2, 53.33\% of patients had an ASA score of 3 and 20\% of patients had an ASA score of 4. While in Group B, 34.11\% of patients had ASA score 2, 47.05\% of patients had ASA score 3 and 18.84 \% of patients had ASA score 4, Table~\ref{tw-bf82b19fe43c}. 

Numerous medical care centers use proof-based therapy conventions for the consideration of old patients with proximal femur cracks. This is likely in light of the enormous number of old patients with hip cracks, the helpless results that these patients experience, and the significant expense of hip break care \unskip~\citep{1039708:21706017}. The exploration supporting the utilization of this model of care has been blended. Different randomized controlled preliminaries have neglected to show huge enhancements in long haul mortality after hip crack a medical procedure with this model of care. \unskip~\citep{1039708:21706021,1039708:21706020} In an accomplice correlation by Pedersen et al. 1 of 535 patients with hip breaks treated inside a multidisciplinary hip crack program, the general 1-year mortality was 23\% contrasted and 29\% for the individuals who were treated with normalized care. Notwithstanding, this improved mortality was just a pattern in the Kaplan-Meier investigation and not huge (P \ensuremath{\frac14}  .2) \unskip~\citep{1039708:21706024} contrasted co oversaw patients and controls and uncovered 1-year mortalities of 25\% and 35.3\%, individually. Notwithstanding, patient consideration and rejection rules were not clear. In our investigation of 100 patients, the death rate was 15\%. 

Introductory examinations depicted an in-clinic death pace of 1.5\% for a lot more modest accomplice of patients. The considerably lower mortality at 1 year in this program was not anticipated. The 1-year unadjusted death pace of 21.2\% is lower than other distributed investigations of patients treated in normal consideration when including systematized patients. Different investigations, including co-administration of patients, have cited lower death rates at 1 year; however, they avoided patients with dementia, nursing home occupants, or non-ambulatory patients who commonly have various clinical comorbidities \unskip~\citep{1039708:21706027}.

The Parker portability score is a device to survey preinjury versatility capacity and help separate 1-year mortality after proximal femur fractures \unskip~\citep{1039708:21706025}. We found that this list was prescient of 1-year mortality in our investigation population. The ORs of 1-year mortality were 2.79 (P \ensuremath{\frac14}  .01) and (P \ensuremath{\frac14}  .05) for low (0-4) and medium (5-8) portability scores, individually. A planned 10-year study found that patients requiring an assistive gadget for ambulation before their hip crack had a 28\% expanded danger of mortality. Likewise, patients who were restricted to ambulation inside their home had 2.2 occasions more serious danger of mortality. In our examination, among Group A most extreme Parker Mobility Score was 5, least was 1, the normal being 3. In Group B, the most extreme Parker Mobility Score was 9, least was 4, the normal being \unskip~\citep{1039708:21706028}. 

Furthermore, the nursing home population has a high commonness of osteoporosis and falls \unskip~\citep{1039708:21706026,1039708:21706025,1039708:21706023} have shown 1-year death rates in hip break patients from nursing homes to be 36\% for ladies and 54\% for men. A new 3-year study surveying Medicare patient cases for intertrochanteric hip cracks found the 90-day death rate was twofold for nursing home residents \unskip~\citep{1039708:21706018}. However, subsequent to adapting to different qualities, like preoperative comorbidity and capacity, there could have been not, at this point, a critical distinction among local area and noncommunity inhabitants. 

47\% of our examination population was determined to have dementia before their hip break. The 1-year death pace of deranged patients was 29.3\% versus 13.9\% for those without dementia (P \textless\ .0001). Patients with dementia are known to have higher death rates after hip cracks. 

A 5-concentrate by Khan et al. of hip cracks uncovered a 1-year death pace of 28\% of patients with serious dementia versus 12\% without. An investigation by 376 patients with hip breaks uncovered a 2-year death pace of 26.4\% in patients with dementia versus 6.5\% with those without dementia \unskip~\citep{1039708:21706022}. In our investigation, 6.67\% of patients among Group A had a history of Dementia.

This investigation, just as others, shows expanded mortality after the medical procedure with expanding age 20-23. Mortality was 2\% for patients more youthful than 70 years and over 27\% for those matured 90 years or more established. In an investigation of 612 patients, Aharonoff et al. found that an age {\textgreater}85 years was prescient of 1-year mortality. Nonetheless, different investigations have not shown a huge relationship between age and mortality after hip fracture. Richmond et al. found an essentially expanded mortality danger in patients in the 64-to 85-year-old gathering as contrasted and those more seasoned than 85 years \unskip~\citep{1039708:21706023} showed that in an investigation of 195 nursing home inhabitants matured 65 years and more seasoned with hip breaks, there was a 30\% increment in mortality with like clockwork of propelling age. These discoveries are to be expected, as one would anticipate expanded mortality with expanding age. 

Patients with a Charlson score of 4 or more prominent were found to have double the danger of death before 1 year. Studies have utilized the CCI to survey hazard and foresee 1-year mortality. 28-32 The CCI utilizes a total score of comorbidities to give prognostic data. 33 Roche et al. 34, in their investigation of 2448 hip breaks, found that having at least 3 clinical comorbidities was identified with higher entanglement rates and mortality \unskip~\citep{1039708:21706019} contemplated 495 hip cracks and found that patients with at least 3 comorbid conditions were 65\% bound to kick the bucket than those with less conditions. In our investigation, among Group A most extreme Charles Comorbidity Index was 8 (assessed long term endurance rate 0\%), least was 3 (assessed long term endurance rate 77\%), the normal score being 5.73. In Group B most extreme Charles Comorbidity Score was 5 (assessed long term endurance rate 21\%), least was 1 (assessed long term endurance rate 96\%), the normal score being 3.18. 

As per score rules, the most extreme score conceivable is 31, while the base score is 1. 

In our investigation, among Group A, the greatest score was 18 and the least score was 9; the normal score was 13.73. While in Group B, the most extreme score was 8, and the least score was 2; the normal score was 4.95.

This investigation has a few qualities. It incorporates a huge accomplice of patients. The investigation characterizes factors that foresee 1-year mortality after hip breaks. What's more, it offers to back to the usage of a co-administration model for the treatment of patients with hip cracks. The impediments incorporate the review plan and the absence of controls. Also, the number of men and minorities were restricted, and the information may not be appropriate to all geriatric populations. 
    
\section{Conclusion}
In reference to a standard index, like the Charlson Comorbidity Index, we can conclude that this score gives us information about possible mortality/morbidity of the patient of proximal 1/3\ensuremath{^{rd }}femur fracture. The outcome of the Comorbidity Index determines the deceased patients had an average of 13.73 Comorbidity Index Score; whereas the non-deceased patients had an average of 4.95 Comorbidity Index Score This score can also be helpful in providing counselling to the patient and patient's relative  about the patient's outcome for surgery. This score will also prove useful in reducing medicolegal complications and will be documented and explained to the patient's relatives. This score is comparable  to the Charlson Comorbidity Index for predicting a patient's outcome following surgery. 

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that they haver no conflict of interest for this study.
    

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