Abigail Sagona, BA

She/Her/Hers
Clinical Research Coordinator
Orthopedics
Orthopaedic Trauma
Frailty is Associated with Increased Mortality and Re-admission in Geriatric Hip Fractures

Principal Investigator: Arvind von Keudell, MD

Authors: Carlos Ortega, BS Abigail Sagona, BA Liqin Wang, PhD Faith Sezer, PhD Li Zhou, MD, PhD Arvind von Keudell, MD
Lay Abstract

Methods: We identified patients who were ≥65 years old, underwent surgical repair of a femoral neck or intertrochanteric hip fracture, co-managed by the orthopedic trauma and geriatric services at BWH between May 2018 and August 2020. Demographic and clinical data were extracted from Mass General Brigham (MGB)’s Enterprise Data Warehouse and verified by chart review. FI scores were categorized as: Non-Frail/Pre-Frail (FI <0.21, n=62), Frail (0.21≤FI<0.45, n=185), and Severely Frail (FI > 0.45, n=69). One-year outcomes were calculated using Kaplan-Meier methods and compared using log-rank statistics. This study was approved by the MGB Institutional Review Board.

 

Results: 316 patients with hip fractures who underwent surgical repair and had a frailty index score assigned were identified. At baseline the mean age was 83.8 (SD 7.9) years and the mean FI was 0.33 (SD 0.14). Patients were predominantly white 278 (88.0%) and female 221 (69.9%). Femoral neck fractures accounted for 129 (40.8%) of cases and intertrochanteric fractures accounted for 187 (59.2%) of cases. By one-year (Figure 1), freedom from readmission was 62.0%, 44.4%, and 25.8% (p=0.001) in the non/pre-frail, frail, and severely frail groups, respectively. Similarly, one-year survival rates were 100%, 84.0%, and 51.2% (p<0.001) in the respective frailty groups.

Scientific Abstract

Frailty index (FI) is a tool used to help clinicians determine how well a patient may do after orthopedic trauma surgery. We evaluated the association between FI and both mortality and hospital re-admission in 316 patients who underwent surgery for a femoral neck or an intertrochanteric hip fracture. Our data suggests that FI stratification can help to identify a sub-set of patients at high risk for adverse outcomes following hip fracture. Our preliminary analyses appear to suggest that it may be a stronger risk factor of mortality than age alone.

Clinical Implications
We found that higher FI is associated with higher adverse outcomes at one-year. Freedom from hospital readmission and survival were associated with better frailty categories. Further analyses will evaluate the role of age itself in relation adverse outcomes following repair of hip fractures. Our findings suggest that FI has a role in identifying high risk surgical candidates and FI may help guide clinical decision making.

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