The prognostic value of the 5-factor modified frailty index in patients with proximal femur fractures followed up in the postoperative intensive care unit: a retrospective cohort study
Aug 2026· Journal of Medicine and Palliative Care· Vol 7, pp. 804-812· 0 citations· 22 references
TL;DR
The prognostic value of the 5-factor modified frailty index (mFI-5) in patients with proximal femur fractures who were monitored in the postoperative intensive care unit (ICU) and to evaluate its relationship with clinical outcomes was demonstrated.
Abstract
Aims: Proximal femur fractures pose a major problem for geriatric patients due to both their increasing incidence and their adverse postoperative outcomes. Based on this, we aimed to demonstrate the prognostic value of the 5-factor modified frailty index (mFI-5) in patients with proximal femur fractures who were monitored in the postoperative intensive care unit (ICU) and to evaluate its relationship with clinical outcomes. Methods: This retrospective cohort study included 246 patients between August 2023 and February 2026. Demographic data, laboratory and clinical outcomes, and ICU and 90-day mortality rates were recorded. Receiver operating characteristic (ROC) curve analysis and logistic regression analysis were performed to assess the prognostic value of the mFI-5. Results: Twenty-seven patients (10.98%) died in the ICU. In patients with an mFI-5 score of ≥2, the need for vasopressors, invasive mechanical ventilation, and postoperative sepsis was significantly higher (p=0.008, p=0.01, and p=0.037, respectively). In addition, ICU mortality was also higher in this group (p=0.008). Upon examination of ROC curve analyses, the AUC value for mFI-5 was 0.706, and the cutoff value was 2 (p
In this study, ASA-PS and CFS demonstrated comparable performance in predicting ICU admission; however, neither scale retained independent predictive value after adjustment for age, coronary artery disease, and type of anesthesia.
D. Kalaycı, T. Aşkın· Journal of Clinical Medicine· 0 citations
Abstract Background/Objective/Introduction Hip fractures in older patients are associated with substantial morbidity and in-hospital mortality. Despite the clinical importance of this condition, few tools specifically estimate in-hospital mortality or account for clinical deterioration during hospitalization, particularly in middle-income settings. This study aimed to develop a dynamic prognostic score to estimate the risk of in-hospital mortality among older patients undergoing surgical treatment for hip fractures. Materials and Methods A retrospective cohort study was conducted with 1,509 patients aged 60 years and older treated at a Brazilian trauma centre between 2013 and 2023. Demographic, clinical, orthopaedic, laboratory and in-hospital evolution variables were analysed. Independent predictors of mortality were identified using binary logistic regression. A prognostic score was constructed using weights derived from the magnitude of association (odds ratios) observed in the logistic regression. Model accuracy was assessed by the area under the ROC curve (AUC). Patients were stratified into four in-hospital death risk categories: low, moderate, high, and very high. Results The in-hospital mortality rate was 3.7%. Independent predictors included dementia, acute myocardial infarction, heart failure, and abnormalities in creatinine, potassium, and INR. In-hospital events including pulmonary thromboembolism, need for blood transfusion, and postoperative ICU admission were also strongly associated with death. The final score showed good discriminative performance with an AUC of 0.819. Predicted in-hospital mortality increased progressively across the risk groups, from 3%, among low-risk patients to > 20% among very-high-risk patients. Conclusions The In-Hospital Hip Fracture Mortality Score demonstrated good predictive ability for in-hospital mortality in older surgically treated patients with hip fractures. However, it should be considered a preliminary hospital-based tool, and external validation in independent cohorts is needed before routine clinical implementation
Erica Blenda da Silva, Fernanda Yuri Yuamoto, M. W. Perroud Junior et al.· Annals medicus· 0 citations
BACKGROUND Hip fractures (HFs), which are common in the geriatric population and have a high mortality rate, are among the pathologies frequently encountered in emergency departments (EDs). The aim of this study was to investigate the prognostic value of red cell distribution width (RDW) and modified 5-item frailty index (mFI-5) scores in the prediction of short-term mortality and intensive care unit (ICU) admission in patients with HFs. METHODS Patients who presented to the ED due to HF between January 01, 2019, and December 31, 2023, were evaluated. Patients who underwent surgery for femoral neck, intertrochanteric, or subtrochanteric fractures were included in the study. Baseline demographics (age and sex), comorbidities, ICU admission status, and in-hospital and 30-day mortality rates were recorded. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of ICU admission and 30-day mortality. RESULTS A total of 413 patients undergoing surgical treatment for HFs were included. The mean age of the patients was 80±11 years, and 271 (65.6%) were female. ICU admission was required for 43 patients (10%), while in-hospital and 30-day mortality rates were 7% (n=30) and 9.9% (n=41), respectively. Multivariable logistic regression analysis identified RDW as an independent predictor of both ICU admission (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05–1.41; p=0.009) and 30-day mortality (OR 1.20, 95% CI 1.03–1.39; p=0.016). Atrial fibrillation (AF) and Alzheimer’s disease were also identified as independent predictors of ICU admission, while AF and age independently predicted 30-day mortality. The mFI-5 score did not reach statistical significance in univariate analysis for either outcome. A predictive model incorporating RDW and other covariates achieved area under the curve values of 0.74 for ICU admission and 0.70 for 30-day mortality. CONCLUSION RDW emerged as an independent predictor of ICU admission and 30-day mortality in surgically managed HF patients, with improved discriminatory performance when integrated into a multiparametric model. Advanced age, Alzheimer’s disease, and AF further contribute to increased risk and should be closely monitored in clinical management. These findings support the incorporation of RDW into routine emergency risk stratification for this vulnerable population.
Selim Değirmenci, Hakan Tırın, Erhan Arıkan et al.· Ulusal Travma Ve Acil Cerrah...· 0 citations
OBJECTIVE
Frailty is a recognized risk factor for poor surgical outcomes, particularly in the elderly. This study evaluates the predictive value of the 5-item Modified Frailty Index in patients aged 70 and older undergoing head and neck cancer resection with microvascular free flap reconstruction.
STUDY DESIGN
Retrospective cohort study.
SETTING
Tertiary academic medical center.
METHODS
Patients aged ≥ 70 years old who underwent oncologic resection and free flap reconstruction from 2014 to 2022 were included. Patients were stratified by 5-item Modified Frailty Index score into non-frail (0), mildly frail (1), and moderately to severely frail (≥2). Primary outcomes included 90-day mortality, 30-day complications, readmission, and return to the operating room. Multivariable logistic regression was used to control potential confounders.
RESULTS
A total of 211 patients were included. Patients with 5-item Modified Frailty Index scores ≥ 2 had significantly higher 90-day mortality compared to less frail patients (p = 0.031), and they were more frequently discharged to a facility rather than home. While not statistically significant, complication and readmission rates were higher in frail patients. Multivariable analysis showed that patients with 5-item Modified Frailty Index ≥ 2 had increased odds of experiencing complications (OR 2.44, 95 % CI 1.06-5.91)and mortality (OR 1.17, 95 % CI 0.36-4.59).
CONCLUSION
The 5-item Modified Frailty Index is a simple and clinically useful tool for identifying older head and neck cancer patients at increased risk of adverse outcomes following major surgery. Its incorporation into preoperative risk assessment may improve surgical decision-making and perioperative planning by better stratifying risk and guiding resource allocation.
John J Sykes, Edgar D Uribe Sanchez, D. Benito et al.· Oral Oncology· 1 citation
Background: Hip fracture surgery patients admitted to the intensive care unit (ICU) have high postoperative mortality, and early risk stratification remains challenging. This study aimed to evaluate the predictive value of the C-reactive protein/albumin ratio (CAR) for 30-day and 90-day mortality in hip fracture surgery patients admitted to the ICU. Methods: This retrospective cohort study included 134 adult patients who underwent surgery for hip fracture and were admitted to the ICU between June 2021 and June 2023. Demographic characteristics, comorbidities, APACHE II and SAPS II scores, and laboratory parameters measured within the first 24 h of ICU admission were recorded. CAR was calculated by dividing CRP (mg/L) by albumin (g/dL). The primary outcomes were 30-day and 90-day mortality. Cox proportional hazards regression analysis was performed to identify independent predictors of mortality, and receiver operating characteristic (ROC) curve analysis was used to assess the discriminative ability of CAR. Results: The 30-day and 90-day mortality rates were 10.4% and 22.4%, respectively. CAR and serum albumin levels were significantly associated with both 30-day and 90-day mortality (p < 0.01), whereas CRP alone was not. In ROC analysis, CAR demonstrated excellent predictive performance for 30-day mortality (AUC: 0.991; 95% CI: 0.975–1.000; cutoff: 38.46; sensitivity: 92.9%; specificity: 92.5%) and good performance for 90-day mortality (AUC: 0.847; 95% CI: 0.776–0.918; cutoff: 25.43). Cox regression analysis identified CAR as an independent predictor of both 30-day (Exp(B) = 1.048, p < 0.001) and 90-day mortality (Exp(B) = 1.025, p = 0.002). Conclusions: The CRP/albumin ratio is a strong and independent predictor of short- and mid-term mortality in hip fracture surgery patients admitted to the ICU. Due to its simplicity and rapid availability, CAR may serve as a practical adjunctive biomarker for early risk stratification in this high-risk population.
Ayşe Yılmaz, V. G. Soylu, Ö. Taşkın et al.· Life· 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
