Is there an optimal perioperative risk assessment tool for older adult ankle fractures?

Abstract

Objective

To measure the predictive value of three perioperative risk assessment tools (National Surgical Quality Improvement Program–NSQIP, Modified 5-factor Frailty Index–mFI-5, and Score for Trauma Triage in Geriatric and Middle Aged–STTGMA) in predicting postoperative complications in older adult ankle fractures.

Materials and methods

This is a retrospective study of surgically treated isolated older adult ankle fractures at an academic center between 2007 and 2022. Exclusion criteria included age < 55 years, presence of pathologic fractures, and having multiple orthopaedic injuries. Patient sociodemographic information, injury characteristics, clinical outcomes, and complications were obtained. Data was entered into the NSQIP, mFI-5, and STTGMA calculators. Descriptive statistics and univariable logistic regression models were calculated for each outcome of interest. Area under the receiver operative curves (AUC) were determined as a measure of tool discrimination.

Results

382 patients met inclusion criteria. The average age was 67 years, 33% were male, and 87% ambulated without assistive devices prior to injury. 23.6% of all patients had a complication: 12.8% had at least one minor complication, 15.7% had at least one major complication, and 2.4% had surgical complications. Mortality within 1 year of initial injury was 2.9%. NSQIP was the best predictor of any complication (AUC 0.74) compared to the mFI-5 (AUC 0.68), and STTGMA (AUC 0.72).

Conclusions

NSQIP performed better than mFI-5, STTGMA, and CCI for postoperative complications and mortality, but none of the perioperative risk assessment tools performed exceptionally well in the context of isolated older adult ankle fractures.