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. 2025 Jan 30;25(1):65.
doi: 10.1186/s12877-025-05716-z.

Association between frailty, as measured by the FRAIL scale, and 1-year mortality in older patients undergoing hip fracture surgery

Shaohua Xi  1 , Zhibin Wu  2 , Jian Cui  3 , Suran Yin  1 , Shaozhi Xi  4 , Chaoyang Liu  5
Affiliations

Association between frailty, as measured by the FRAIL scale, and 1-year mortality in older patients undergoing hip fracture surgery

Shaohua Xi et al. BMC Geriatr. .

Abstract

Background: The FRAIL scale is a concise and user-friendly tool for frailty assessment. However, its effectiveness in predicting 1-year mortality among older patients undergoing hip fracture surgery remains unclear. This study explored the relationship between preoperative frailty, as measured by the FRAIL scale, and 1-year mortality after surgery in this population.

Methods: This retrospective analysis included 194 older patients (aged ≥ 75 years) with hip fractures who underwent surgical treatment in our departments from January 2019 to December 2022. Perioperative clinical data were collected, and all-cause mortality within 1 year after surgery was monitored. Patients were categorized into non-frail (n = 114) and frail (n = 80) groups based on their FRAIL scores. Postoperative complications and 1-year mortality rates were compared between these groups. The association of preoperative frailty with 1-year mortality and its predictive capability were assessed.

Results: Among the 194 older hip fracture patients, 78 (40.2%) were male, with a mean (standard deviation [SD]) age of 84.4 (6.3) years. The overall incidence of 1-year mortality after surgery was 11.3% (22/194). Frail patients had a higher incidence of Clavien-Dindo (CD) classification of surgical complications ≥ II (31.3% vs. 12.3%, p = 0.00) and greater 1-year mortality (21.3% vs. 4.4%, p = 0.00) compared with non-frail patients. Cox regression analysis indicated that preoperative frailty was independently associated with 1-year mortality (adjusted hazard ratio: 3.88; 95% confidence interval [CI]: 1.28-11.77; p = 0.02). The FRAIL scale demonstrated acceptable discriminatory capacity for predicting 1-year mortality in these patients (area under the curve: 0.70; 95% CI: 0.59-0.81).

Conclusions: Frailty, as measured by the FRAIL scale, was independently associated with 1-year mortality in older patients undergoing hip fracture surgery. The scale can be used to stratify risk and facilitate personalized perioperative treatment and management.

Keywords: All-cause mortality; Frailty; Hip fracture; Older adults.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Clinical Research Ethics Committee of Chinese PLA General Hospital and the Second Affiliated Hospital of Xingtai Medical College, respectively. The study was conducted in accordance with the Declaration of Helsinki. We confirmed that all methods were carried out in accordance with relevant guidelines and regulations to protect human subjects. In addition, due to the retrospective nature of the study, the requirement for written informed consent from participants was waived by the Clinical Research Ethics Committee of Chinese PLA General Hospital and the Second Affiliated Hospital of Xingtai Medical College, respectively. Consent for publication: Not applicable. Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Rating for patients across risk categories of the FRAIL Scale. P-value is for the comparison across the risk categories of the scoring system
Fig. 2
Fig. 2
Cumulate 1-year survival rate according to risk stratification based on the FRAIL Scale. The Kaplan Meier curve for the cumulative 1-year survival rates between frailty and non-frailty groups. Log-rank test shows statistically significant difference between the two groups
Fig. 3
Fig. 3
Receiver-operating characteristic curve for predicting 1-year mortality in elderly patients with hip fracture surgery using the FRAIL Scale for frailty (AUC 0.70, 95%CI: 0.59–0.81)
See this image and copyright information in PMC

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