1. In a cohort of older adults undergoing surgery for a hip fracture, the presence of pre-operative frailty was associated with increased post-operative complications.
Evidence Rating Level: 2 (Good)
Hip fractures in the elderly represent a high source of morbidity and mortal in the older adult population. Surgery is often the best treatment for such fractures however it can lead to various adverse events in this population. Although previous studies have explored the relationship between frailty and post-operative complications, most were conducted in western countries, limiting their generalizability worldwide. This retrospective cohort study aimed to determine the effectiveness of a preoperative modified frailty index (mFI) in predicting post-operative complications in older Chinese patients with hip fractures. The primary outcomes measured were post-operative complications (divided into severity grades I, II, and III) and in-hospital pneumonia. Of 965 patients included in the study (66% female; mean age=76.77 years), 126 were in the frailty group. The median (range) mFI score was 0.12 (0-0.39). The study found that greater number of patients without frailty had no complications versus those with frailty (77.7% versus 61.9%). The odds of having a higher grade (I, II, or III) complication was increased in those with frailty compared to adults without frailty (OR, 2.07; 95% CI, 1.40-3.05; p < 0.001). Additionally, for an increase in mFI score by 0.01, the risk of severity grades of all post-operative complications increased by 1.07 (95% CI, 1.04-1.09). Patients with frailty were more likely to develop in-hospital pneumonia than their non-frail counterparts (20.6% versus 11.1%) and they demonstrated a statistically increased risk of developing in-hospital pneumonia (OR, 2.08; 95% CI, 1.28-3.39; p=0.003). Finally, an increase in mFI score by 0.01 increased the risk of developing in-hospital pneumonia by 1.07 (95% CI, 1.05-1.10). Overall, the study concluded that increased frailty was associated with increased risk of post-operative complications and in-hospital pneumonia. It was an important study demonstrating that frailty is useful prognostic information in this population.
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