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. 2015 Sep;6(3):209-14.
doi: 10.1177/2151458515591170.

Frailty and Short-Term Outcomes in Patients With Hip Fracture

Elizabeth A Kistler  1 , Joseph A Nicholas  1 , Stephen L Kates  2 , Susan M Friedman  1
Affiliations

Frailty and Short-Term Outcomes in Patients With Hip Fracture

Elizabeth A Kistler et al. Geriatr Orthop Surg Rehabil. 2015 Sep.

Abstract

Objectives: To assess the prevalence of frailty and its ability to predict short-term outcomes in older patients with hip fracture.

Design: Prospective cohort study.

Setting: University-affiliated community hospital.

Participants: Thirty-five patients aged ≥65 treated with hip fracture.

Measurements: Frailty was assessed using the 5 criteria of the Fried Frailty Index, modified for a post-fracture population. Cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA). The primary outcome was overall hospital complication rate. Secondary outcomes were length of stay (LOS) and specific complications. Differences between the frail and the non-frail were identified using chi-square analysis and analysis of variance (ANOVA) for categorical and continuous variables, respectively.

Results: Eighteen (51%) participants were frail. Seventeen (49%) had ≥1 hospital complication. Twelve (67%) frail patients versus 5 (29%) non-frail patients had a complication (P = .028). Mean LOS was longer in patients with frailty (7.3 ± 5.9 vs 4.1 ± 1.2 days, P = .038). Most were frail for the weakness criterion (94%), and few were frail for the physical activity criterion (9%). Excluding these criteria, we developed a 3-criteria frailty index (shrinking, exhaustion, and slowness) that identified an increased risk of complications (64.7% vs 33.3%, P = .061) and LOS (7.4 ± 6.1 vs 4.2 ± 1.3 days, P = .040) in participants with frailty. Among non-frail participants with a high MoCA score of ≥20 (n = 12), 2 (17%) had complications compared to 10 (71%) frail participants with a low MoCA score (n = 14).

Conclusion: Frailty is common in older patients with hip fracture and associated with increased LOS and postoperative complications. A low MoCA score, a hypothesized marker of more advanced cognitive frailty, may further increase risk. Frailty assessment has a role in prognostic discussion and care planning. The 3-criteria frailty index is an easily used tool with potential application in clinical practice.

Keywords: frailty; hip fracture; prognosis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Elizabeth Kistler, Susan Friedman, and Joseph Nicholas have no potential conflicts of interest with respect to the authorship and/or publication of this article. Stephen Kates has the following potential conflicts of interest: He receives grants from the National Institutes of Health (NIH), Agency for Healthcare Research and Quality (AHRQ), Orthopaedic Research and Education Foundation (OREF), and AOTrauma. He is employed by Sage Publications in the role of Journal Editor for Geriatric Orthopaedic Surgery and Rehabilitation. He receives support for meetings and travel in affiliation with the following organizations: American Academy of Orthopaedic Surgery (AAOS), American Orthopaedic Association (AOA), and the AO Foundation. He is a consultant for Surgical Excellence. He is a board member of the International Geriatric Fracture Society.

Figures

Figure 1.
Figure 1.
Geriatric Hip Fracture Frailty Assessment Tool. This assessment tool is based on the 3-criteria frailty index derived from the modified Fried Frailty Index. Criterion A measures shrinking, criterion B exhaustion, and criterion C slowness.
See this image and copyright information in PMC

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