The association between preoperative modified frailty index and postoperative complications in Chinese elderly patients with hip fractures

Abstract Objectives To investigate the role of a preoperative modified frailty index (mFI) based on data from medical records in predicting postoperative complications among older Chinese patients with hip fractures. Methods This retrospective cohort study included consecutive older patients with hip fracture admitted to the Department of Orthopaedics, West China Hospital, Sichuan University, from December 2010 to June 2017 who underwent surgical repair. We selected 33 variables, including characteristics of hip fracture, to construct a mFI. Each variable was coded with a value of 0 when a deficit was absent or 1 when it was present. We calculated the mFI as the proportion of positive items and defined frailty as mFI value greater than or equal to 0.21 according to threshold proposed by Hoover et al. We examined the relationship between mFI and severity of postoperative complications and the occurrence of in-hospital pneumonia including statistical adjustment for several demographics (e.g. age, gender, and marital status) and habits (smoking and alcohol intake), time from fracture to surgery in the multivariable model. Results We included 965 patients (34% male; mean age: 76.77 years; range: 60 to 100 years) with a prevalence of frailty of 13.06%. The presence of frailty was associated with a higher severity of complications (OR: 2.07; 95% CI: 1.40 to 3.05). Frail patients were more likely to develop in-hospital pneumonia than non-frail patients (OR: 2.08; 95% CI: 1.28 to 3.39). Conclusion The preoperative modified frailty index based on data from medical records proved significantly associated with postoperative complications among older patients with hip fractures undergoing hip surgery.

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The composite risk index based on frailty predicts postoperative complications in older patients recovering from elective digestive tract surgery: a retrospective cohort study

BMC Anesthesiology ◽

10.1186/s12871-021-01549-6 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Chun-Qing Li ◽

Chen Zhang ◽

Fan Yu ◽

Xue-Ying Li ◽

Dong-Xin Wang

Keyword(s):

Cohort Study ◽

Postoperative Complications ◽

Digestive Tract ◽

Older Patients ◽

Retrospective Cohort ◽

Risk Index ◽

Frailty Index ◽

Modified Frailty Index ◽

Digestive Tract Surgery ◽

Composite Risk

Abstract Background Limitations exist in available studies investigating effect of preoperative frailty on postoperative outcomes. This study was designed to analyze the association between composite risk index, an accumulation of preoperative frailty deficits, and the risk of postoperative complications in older patients recovering from elective digestive tract surgery. Methods This was a retrospective cohort study. Baseline and perioperative data of older patients (age ≥ 65 years) who underwent elective digestive tract surgery from January 1, 2017 to December 31, 2018 were collected. The severity of frailty was assessed with the composite risk index, a composite of frailty deficits including modified frailty index. The primary endpoint was the occurrence of postoperative complications during hospital stay. The association between the composite risk index and the risk of postoperative complications was assessed with a multivariable logistic regression model. Results A total of 923 patients were included. Of these, 27.8% (257) developed postoperative complications. Four frailty deficits, i.e., modified frailty index ≥0.27, malnutrition, hemoglobin < 90 g/L, and albumin ≤30 g/L, were combined to generate a composite risk index. Multivariable analysis showed that, when compared with patients with composite risk index of 0, the odds ratios (95% confidence intervals) were 2.408 (1.714–3.383, P < 0.001) for those with a composite risk index of 1, 3.235 (1.985–5.272, P < 0.001) for those with a composite risk index of 2, and 9.227 (3.568–23.86, P < 0.001) for those with composite risk index of 3 or above. The area under receiver-operator characteristic curve to predict postoperative complications was 0.653 (95% confidence interval 0.613–0.694, P < 0.001) for composite risk index compared with 0.622 (0.581–0.663, P < 0.001) for modified frailty index. Conclusion For older patients following elective digestive tract surgery, high preoperative composite risk index, a combination of frailty deficits, was independently associated with an increased risk of postoperative complications.

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Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211016252 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110162

Author(s):

Matthew S. Broggi ◽

Philip O. Oladeji ◽

Syed Tahmid ◽

Roberto Hernandez-Irizarry ◽

Jerad Allen

Keyword(s):

Risk Factor ◽

Hip Fracture ◽

Postoperative Complications ◽

Hip Fractures ◽

Depressive Disorders ◽

Surgical Site Infections ◽

Wound Complications ◽

Non Union ◽

Hip Fracture Surgery ◽

Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

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Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery

BMC Geriatrics ◽

10.1186/s12877-021-02584-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

R. Gamberale ◽

C. D’Orlando ◽

S. Brunelli ◽

R. Meneveri ◽

P. Mazzola ◽

...

Keyword(s):

Hip Fracture ◽

Older People ◽

Older Patients ◽

Postoperative Delirium ◽

Frailty Index ◽

Pathophysiological Mechanisms ◽

Hip Fracture Surgery ◽

Endothelial Dysfunctions ◽

Fracture Surgery ◽

Pathophysiologic Mechanisms

Abstract Background Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. Methods Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient’s functional status at discharge, using the Cumulated Ambulation Score. Discussion This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.

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Frailty Predicts Decreased Survival, More Complications, and Higher Hunt & Hess and Fisher Scores Following an Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽

10.1093/neuros/nyz310_307 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Matthew McIntyre ◽

Vikas Patel ◽

Andrew Long ◽

Alex Vonhoof ◽

Boyi Li ◽

...

Keyword(s):

Independent Predictor ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Frailty Index ◽

Survival Curves ◽

Rank Analysis ◽

Frail Patients ◽

Kaplan Meier ◽

Discharge Location ◽

Modified Frailty Index ◽

To Receive

Abstract INTRODUCTION Aneurysmal SAH (aSAH) is associated with high rates of morbidity and mortality, yet frailty's effect on aSAH outcomes has not been explored. The most common method of measuring frailty is via the modified frailty index (mFI). We hypothesized that increasing frailty is associated with poorer outcomes following an aSAH. METHODS Patients with aSAH were retrospectively identified from angiogram records. The cohort was divided into nonfrail (mFI = 0-1) and frail (mFI = 2) groups based on prehemorrhage characteristics. Primary outcomes were mortality, discharge location, complications (without vasospasm), and vasospasm. Groups were compared using Fishers exact or Mann-Whitney tests, and Kaplan-Meier survival curves were generated for Log-Rank analysis. RESULTS A total of 217 patients with aSAH were identified, 57 of whom were classified as frail (mean mFI = 1.0 ± 0.08). The average Hunt & Hess (HH) and Fisher scores were 2.9 ± 0.09 and 3.7 ± 0.04, respectively. 167 (77%) of patients had = 1 complication, 124 (57.1%) developed vasospasm, but only 41 (18.9%) died, and 74 (34%) were discharged home. Frail patients were significantly older (66 vs 55 yr; P < .0001), had higher rates of hyperlipidemia (OR = 2.2; 95% CI: 1.2-4.3; P = .0219), and had higher HH (P = .005) and Fisher (P = .0255) scores. Frail patients were less likely to receive an intervention (OR = 0.3; 95% CI: 0.1-0.6; P = .0056), less likely to be discharged home (OR = 0.32; 95% CI: 0.16-0.68; P = .0020), had a higher mortality rate (OR = 2.4; 95% CI: 1.2-5; P = .0183), and were more likely develop a complication (OR = 2.6; 95% CI: 1.1-6.6; P = .0277). Log-Rank testing of Kaplan-Meier curves found that frail individuals have a significantly decreased survival compared to non-frail individuals (X2 (1) = 6.939; P = .0084). There were no differences in vasospasm rates between groups. CONCLUSION Frailty is an independent predictor of higher HH and Fisher scores following aSAH, along with lower rates of aneurysm intervention, discharge home, and survival. This relationship has never been demonstrated for aSAH and is valuable for risk stratification and prognostication in aSAH patients.

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Association of a Modified Frailty Index with Postoperative Outcomes after Ankle Fractures in Patients Aged 50 Years and Older

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000225 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002 ◽

Cited By ~ 1

Author(s):

Rishin Kadakia ◽

Jason Bariteau ◽

Catphuong Vu ◽

Andrew Pao ◽

Shay Tenenbaum

Keyword(s):

Multivariate Analysis ◽

Postoperative Complications ◽

Assessment Tool ◽

Frailty Index ◽

Reoperation Rate ◽

Ankle Fractures ◽

Postoperative Outcomes ◽

Improvement Project ◽

Modified Frailty Index ◽

Reoperation Rates

Category: Ankle, Trauma Introduction/Purpose: Frailty, a multifaceted syndrome resulting from a decrease in physiologic reserves, has been previously shown to play a significant role in elderly morbidity and mortality. The literature on frailty within orthopaedic surgery is limited currently. No study to date has assessed frailty as a predictor of postoperative outcomes in elderly patients with ankle fractures. We hypothesized that increasing frailty would be associated with increased 30-day reoperation rates and increased postoperative complications. Methods: The National Surgical Quality Improvement Project (NSQIP) was queried using the appropriate CPT codes to identify inpatients from 2005-2014 who were aged 50 years and older that sustained an ankle fracture and underwent operative fixation. Frailty was assessed using a modified frailty index (MFI), abbreviated with 11 variables from the Canadian Study of Health and Aging Frailty Index. The primary outcome was 30-day reoperation rate and secondary outcomes were postoperative surgical and medical complications, readmission rates, and length of stay. Bivariate and multivariate analysis was used to determine association between outcomes and MFI. Results: 6,749 patients were identified, and the mean age of these patients was 64.4 years. Patients with increased MFI scores had significantly higher rates of postoperative complications. In addition, increased MFI scores was also associated with increased 30 day readmissions and reoperations. Multivariate analysis also demonstrated that MFI was a stronger predictor of 30 day reoperation rates (odds ratio of 17.7, P < 0.001) than age, wound class, and ASA class. Conclusion: Frailty has the potential to be an important predictive variable of postoperative outcomes in patients aged 50 years and older who sustain ankle fractures. The modified frailty index can be a valuable preoperative risk assessment tool for the orthopaedic surgeon. Further study is necessary to examine the effect of the MFI in a larger prospective setting.

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New Five-Factor Modified Frailty Index Predicts Morbidity and Mortality in Geriatric Hip Fractures

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000001455 ◽

2019 ◽

Vol 33 (7) ◽

pp. 319-323 ◽

Cited By ~ 25

Author(s):

Sophia A. Traven ◽

Russell A. Reeves ◽

Alyssa D. Althoff ◽

Harris S. Slone ◽

Zeke J. Walton

Keyword(s):

Hip Fractures ◽

Frailty Index ◽

Morbidity And Mortality ◽

Modified Frailty Index

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Evaluating the Use of the Trauma-Specific Frailty Index in Older Patients with Hip Fractures

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.08.631 ◽

2020 ◽

Vol 231 (4) ◽

pp. e235-e236

Author(s):

Daniel Dove ◽

Catsim Fassassi ◽

Juliette Hernandez ◽

Nicolette Tedeschi ◽

Ronald Simon

Keyword(s):

Hip Fractures ◽

Older Patients ◽

Frailty Index

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The 5-Item Modified Frailty Index is Predictive of 30-Day Postoperative Complications in Patients Undergoing Spine Surgery

Spine ◽

10.1097/brs.0000000000003936 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Katherine E. Pierce ◽

Sara Naessig ◽

Nicholas Kummer ◽

Kylan Larsen ◽

Waleed Ahmad ◽

...

Keyword(s):

Postoperative Complications ◽

Spine Surgery ◽

Frailty Index ◽

Modified Frailty Index

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53 Frailty is Not Only a Phenomenon of Elderly Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.057 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S38-S39

Author(s):

Kathleen S Romanowski ◽

Melissa J Grigsby ◽

Soman Sen ◽

Tina L Palmieri ◽

David G Greenhalgh

Keyword(s):

Chart Review ◽

Burn Injury ◽

Frailty Index ◽

Age Groups ◽

Retrospective Chart Review ◽

Burn Injuries ◽

Burn Patients ◽

Chi Square ◽

Frail Patients ◽

Modified Frailty Index

Abstract Introduction Recent evidence indicates that increased frailty is associated with increased mortality in patients with burn injuries over the age of 50 years old. This work found that 35.7% of burn patients over 65 years old were frail at the time of their burn admission while 19.2% of burn patients 50 to 64 years old were frail. While frailty is associated with increased age the two are separate entities suggesting that frailty may be present in much younger patients who present with burn injuries. We hypothesize that frailty exists in all age groups of patients presenting with burn injury and the prevalence increases with age. Methods Following IRB approval, a 5-year (2014–2019) retrospective chart review was conducted of all burn patients admitted to the burn center. Data collected includes age, gender, and burn size (% TBSA). Frailty was determined using the Modified Frailty Index 11 (MFI 11) from co-morbidities included in the burn registry. Patients were considered frail if they have an MFI ³ 2 and pre-frail for an MFI³1 and < 2. Patients were assessed by decades for age. Statistical analysis included descriptive statistics, chi-square, and t-tests. Results A total of 2173 patients (mean age 46.1±17.3 years, 1584 males (72.8%), mean % TBSA 12.5±16.3%) were analyzed. All age groups included patients who were pre-frail (Table 1). In the under 20-year-old group, 8.5% were pre-frail. This increases with each age group to the 71-80-year-old group in which 41.7% of patients are pre-frail. The over 80-year-old group had slightly fewer pre-frail patients (35.9%). There were no frail patients in the under 20-year-old group. In the 21–30 there were 3 patients (0.7%) that had an MFI of 2 or more placing them in the frail group. Frailty was significantly different across the age groups (p< 0.001). As patients age, the proportion of female patients increases (from 17.6% to 37.5%. p< 0.0001). Frailty was also associated with gender with women having a higher percentage of frailty (p=0.0006). With respect to burn size, age category was not associated with burn size (p=0.12), but frail patients had smaller burns than non-frail or pre-frail patients (9.5% vs. 13.3% vs. 12.2%, p=0.0002). Conclusions Pre-frail patients were identified in all age groups. Frailty was present in all age groups except for those who are under 20 years of age. Frailty was associated with female sex and smaller burns. By not specifically looking for frailty in all burn patients admitted to the hospital we are potentially missing frail patients who may benefit from interventions to improve their outcomes.

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