Abstract
ObjectivesTo investigate the role of a preoperative modified frailty index (mFI) based on data from medical records in predicting postoperative complications among older Chinese patients with hip fractures.MethodsThis retrospective cohort study included consecutive older patients with hip fracture admitted to the Department of Orthopaedics, West China Hospital, Sichuan University, from December 2010 to June 2017 who underwent surgical repair. We selected 33 variables, including characteristics of hip fracture, to construct a mFI. Each variable was coded with a value of 0 when a deficit was absent or 1 when it was present. We calculated the mFI as the proportion of positive items and defined frailty as mFI value greater than or equal to 0.21 according to threshold proposed by Hoover et al. We examined the relationship between mFI and severity of postoperative complications and the occurrence of in-hospital pneumonia including statistical adjustment for several demographics (e.g. age, gender, and marital status) and habits (smoking and alcohol intake), time from fracture to surgery in the multivariable model.ResultsWe included 965 patients (34% male; mean age: 76.77 years; range: 60 to 100 years) with a prevalence of frailty of 13.06%. The presence of frailty was associated with a higher severity of complications (OR: 2.07; 95% CI: 1.40 to 3.05). Frail patients were more likely to develop in-hospital pneumonia than non-frail patients (OR: 2.08; 95% CI: 1.28 to 3.39).ConclusionThe preoperative modified frailty index based on data from medical records proved significantly associated with postoperative complications among older patients with hip fractures undergoing hip surgery.
Highlights
Hip fracture is a common type of fracture in the older people
Baseline characteristics From December 2010 to June 2017, 968 patients over 60 years old admitted to West China Hospital of Sichuan University underwent hip fracture surgery, 3 cases with hip fracture and malignant tumor were excluded, 965 patients were included
We found that the odds of being higher level Clavien-Dindo grade was higher in those with frailty than those without frailty (Table 2)
Summary
Hip fracture is a common type of fracture in the older people. According to population dynamics forecast, the incidence of hip fracture will triple by 2050 worldwide (reaching 6.3 million cases) [1]. Hip fractures reduce the quality of life for the older people and incur a heavy financial burden on society [2]. Surgery is the best treatment [3]. Older patients with hip fracture often suffer from chronic diseases and reduced ability to cope with the physiologic stress associated with the fracture. Frailty refers to a geriatric state or syndrome that reflects the body’s decline in physiological reserve and ability to deal with stress and a consequent increase in
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