Abstract
High mortality and dependent living after hip fracture pose a significant public health concern. Retrospective study was conducted with 481 hip fracture patients (≥65 years of age) undergoing surgery from March 2009 to May 2014. The Hip-MFS was calculated by Comprehensive Geriatric Assessment (CGA). The primary outcome was the 6-month all-cause mortality rate. The secondary outcomes were 1-year all-cause mortality, postoperative complications and prolonged hospital stay, and institutionalization. Thirty-five patients (7.3%) died within 6 months after surgery (median [interquartile range], 2.9 [1.4–3.9] months). The fully adjusted hazard ratio per 1 point increase in Hip-MFS was 1.458 (95% confidence interval [CI]: 1.210–1.758) for 6-months mortality and odds ratio were 1.239 (95% CI: 1.115–1.377), 1.156 (95% CI: 1.031–1.296) for postoperative complications and prolonged total hospital stay, respectively. High-risk patients (Hip-MFS > 8) showed higher risk of 6-month mortality (hazard ratio: 3.545, 95% CI: 1.466–8.572) than low-risk patients after adjustment. Hip-MFS successfully predict 6-month mortality, postoperative complications and prolonged hospital stay in elderly hip fracture patients after surgery. Hip-MFS more precisely predict 6-month mortality than age or existing tools (P values of comparison of ROC curve: 0.002, 0.004, and 0.044 for the ASA classification, age and NHFS, respectively).
Highlights
Hip fractures pose a significant public health concern because of reduced life expectancy by 1.8 years and substantial socioeconomic effects with high institutionalization rate of approximately 30% at 6 months after surgery[4,5,6]
Previous studies demonstrated that patients with decreased cognitive function, higher comorbidity, intra-capsular fracture, and prolonged postoperative delirium were susceptible to mortality after hip fracture surgery[8,9]
The risk of in-hospital mortality and major postoperative complications was higher after hip fracture surgery than after elective total hip replacement after matching age, sex, and preoperative medical conditions[10]
Summary
Hip fractures pose a significant public health concern because of reduced life expectancy by 1.8 years and substantial socioeconomic effects with high institutionalization rate of approximately 30% at 6 months after surgery[4,5,6]. Previous studies demonstrated that patients with decreased cognitive function, higher comorbidity, intra-capsular fracture, and prolonged postoperative delirium were susceptible to mortality after hip fracture surgery[8,9]. The risk of in-hospital mortality and major postoperative complications was higher after hip fracture surgery than after elective total hip replacement after matching age, sex, and preoperative medical conditions[10]. The Multidimensional Frailty Score (MFS), derived from the comprehensive geriatric assessment (CGA) with the concept of cumulative deficit and frailty, predicted adverse outcomes in patients undergoing intermediate to high-risk elective operations and in female patients who were designated American Society of Anesthesiologists (ASA) physical status class 1 or 2 and underwent cancer surgery[11,12]
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