BACKGROUND
Femoral neck fractures (FNFs) are common in the elderly and are typically treated operatively. Tools like frailty assessments may be critical for evaluating peri- and postoperative patient needs. Our study evaluated the utility of frailty, measured by the Risk Analysis Index (RAI) and the Modified 5-Item Frailty Index (mFI-5), in predicting 30-day mortality in patients undergoing hemiarthroplasty (HA) or total hip arthroplasty (THA) for FNFs.
METHODS
A national database was queried from 2015 to 2020 for patients 18 years of age or older undergoing HA or THA for FNFs. A total of 14,913 patients who had surgically managed FNFs were included. The primary outcome was 30-day mortality. Multivariate regressions were used to evaluate predictive value, and receiver operating characteristic curves assessed frailty accuracy.
RESULTS
Frailty as measured by the mFI-5 and RAI was predictive of increased odds of 30-day mortality in HA (RAI = odds ratio (OR): 1.46, 95% confidence interval (CI): 1.31 to 1.64; mFI-5 = OR: 1.10 (1.08 to 1.12, P < 0.001 for both)) and THA (RAI = OR: 1.15 (CI: 1.106 to 1.190, P < 0.001), mFI-5 = OR: 1.50 (CI: 1.167 to 1.923, P = 0.002)). The RAI demonstrated superior risk discrimination when compared to the mFI-5 for THA (RAI = C-statistic: 0.84, 95% CI: 0.45 to 0.83 versus mFI-5 = C-statistic: 0.69, 95% CI: 0.68 to 0.71) and HA (RAI = C-statistic: 0.74, 95% CI: 0.73 to 0.75 versus mFI-5 = C-statistic: 0.62, 95% CI: 0.61 to 0.63).
CONCLUSION
Frailty was found to be a predictor of mortality in patients who had FNFs undergoing THA and HA. Compared to the mFI-5, the RAI demonstrated superior predictive value for mortality across both operations. Thus, the RAI may be a powerful tool for assessing preoperative risk in patients undergoing arthroplasty for FNFs.
Ethan Parisier, Victor Koltenyuk, Nithin K. Gupta et al.· Journal of Arthroplasty· 0 citations
With an aging United States population, the incidence of perioperative complications following orthopedic procedures, including surgical management of olecranon fractures, is increasing. These complications affect not only patient outcomes but also discharge disposition. Identifying risk factors for non-routine hospital discharge, including frailty, is critical for optimizing postoperative care and discharge planning in the elderly. We hypothesized that increasing frailty as measured by the modified five-factor frailty index (mFI-5) would be independently associated with non-routine discharge following surgical fixation of olecranon fractures.
The National Inpatient Sample (NIS) was analyzed (2015-2019), focusing on elderly patients (aged ≥ 65 years) with displaced olecranon fractures who underwent surgical fixation. Patients were categorized by frailty status using the modified five-factor frailty index (mFI-5). Adverse hospitalization events and discharge status were compared.
A total of 5185 patients undergoing surgical intervention for displaced olecranon fractures were included in the study. As rated by the mFI-5, 1125 (21.7%) were non-frail, 2565 (49.5%) were prefrail, 1175 (22.7%) were frail, and 320 (6.2%) were severely frail. Age greater than 80 years was an independent risk factor for non-routine discharge [OR: 2.989 (2.640-3.386),
P
< 0.001]. Prefrail, frail, and severely frail patients had a significantly increased likelihood of non-routine discharge [OR: 1.422,
P
< 0.001; OR: 1.857,
P
< 0.001; and OR: 1.478,
P
= 0.010, respectively]. Female sex was also an independent predictor [OR: 1.340 (1.158-1.551),
P
< 0.001].
Frailty, age, and female sex are significant predictors of non-routine discharge in elderly inpatients undergoing surgical fixation for displaced olecranon fractures. These findings highlight the importance of incorporating frailty assessments into both preoperative surgical decision-making and postoperative discharge planning to improve care transitions and outcomes.
Davis Hedbany, Victor Koltenyuk, Matthew Merckling et al.· Montefiore Einstein Journal...· 0 citations
