Abigail Sagona, Carlos A. Ortega, Liqin Wang, Devon T Brameier, Faith Selzer, Li Zhou, Arvind G. von Keudell
{"title":"Frailty is More Predictive of Mortality than Age in Patients with Hip Fractures","authors":"Abigail Sagona, Carlos A. Ortega, Liqin Wang, Devon T Brameier, Faith Selzer, Li Zhou, Arvind G. von Keudell","doi":"10.1097/bot.0000000000002844","DOIUrl":null,"url":null,"abstract":"\n \n To investigate the association between the Comprehensive Geriatric Assessment-based Frailty Index (FI) and adverse outcomes in older adult patients undergoing hip fracture surgery.\n \n \n \n \n \n \n Retrospective cohort study\n \n \n \n Academic Level 1 Trauma Center.\n \n \n \n All patients aged 65 or older who underwent surgical repair of a hip fracture between May 2018 and August 2020 were identified through institutional database review.\n \n Outcome Measures and Comparisons: Data including demographics, FI, injury presentation, and hospital course were collected. Patients were grouped by FI as non-frail (FI < 0.21), frail (0.21≤FI<0.45), and severely frail (FI >0.45). Adverse outcomes of these groups were compared using Kaplan Meier survival analysis. Risk factors for one-year re-hospitalization and two-year mortality were evaluated using Cox hazard regression.\n \n \n \n 316 patients were included, with 62 non-frail, 185 frail, and 69 severely frail patients. The total population was on average 83.8 years old, predominantly white (88.0%), and majority female (69.9%) with an average FI of 0.33 (SD: 0.14). The non-frail cohort was on average 78.8 years old, 93.6% white, and 80.7% female; the frail cohort was on average 84.5 years old, 92.4% white, and 71.9% female, and the severely frail cohort was on average 86.4 years old, 71.0% white, and 55.1% female. Rate of one-year readmission increased with frailty level, with a rate of 38% in non-frail patients, 55.6% in frail patients, and 74.2% in severely frail patients (p=0.001). The same pattern was seen in two-year mortality rates, with a rate of 2.8% in non-frail patients, 36.7% in frail patients, and 77.5% in severely frail patients (p<0.0001). Being classified as frail or severely frail exhibited greater association with mortality within 2 years than age, with hazard ratio of 17.81 for frail patients and 56.81 for severely frail patients compared to 1.19 per 5 years of age.\n \n \n \n Increased frailty as measured by the Frailty Index is significantly associated with increased two-year mortality and one-year hospital readmission rates following hip fracture surgery. Degree of frailty predicts mortality more strongly than age alone. Assessing frailty with the Frailty Index can identify higher-risk surgical candidates, facilitate clinical decision-making, and guide discussions about goals of care with family members, surgeons, and geriatricians.\n \n \n \n Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.\n","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/bot.0000000000002844","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
To investigate the association between the Comprehensive Geriatric Assessment-based Frailty Index (FI) and adverse outcomes in older adult patients undergoing hip fracture surgery.
Retrospective cohort study
Academic Level 1 Trauma Center.
All patients aged 65 or older who underwent surgical repair of a hip fracture between May 2018 and August 2020 were identified through institutional database review.
Outcome Measures and Comparisons: Data including demographics, FI, injury presentation, and hospital course were collected. Patients were grouped by FI as non-frail (FI < 0.21), frail (0.21≤FI<0.45), and severely frail (FI >0.45). Adverse outcomes of these groups were compared using Kaplan Meier survival analysis. Risk factors for one-year re-hospitalization and two-year mortality were evaluated using Cox hazard regression.
316 patients were included, with 62 non-frail, 185 frail, and 69 severely frail patients. The total population was on average 83.8 years old, predominantly white (88.0%), and majority female (69.9%) with an average FI of 0.33 (SD: 0.14). The non-frail cohort was on average 78.8 years old, 93.6% white, and 80.7% female; the frail cohort was on average 84.5 years old, 92.4% white, and 71.9% female, and the severely frail cohort was on average 86.4 years old, 71.0% white, and 55.1% female. Rate of one-year readmission increased with frailty level, with a rate of 38% in non-frail patients, 55.6% in frail patients, and 74.2% in severely frail patients (p=0.001). The same pattern was seen in two-year mortality rates, with a rate of 2.8% in non-frail patients, 36.7% in frail patients, and 77.5% in severely frail patients (p<0.0001). Being classified as frail or severely frail exhibited greater association with mortality within 2 years than age, with hazard ratio of 17.81 for frail patients and 56.81 for severely frail patients compared to 1.19 per 5 years of age.
Increased frailty as measured by the Frailty Index is significantly associated with increased two-year mortality and one-year hospital readmission rates following hip fracture surgery. Degree of frailty predicts mortality more strongly than age alone. Assessing frailty with the Frailty Index can identify higher-risk surgical candidates, facilitate clinical decision-making, and guide discussions about goals of care with family members, surgeons, and geriatricians.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
期刊介绍:
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.