A Prospective Study Correlating Preoperative Modified Frailty Index With One-Year Mortality in the Elderly With Hip Fractures

Abstract

BackgroundHip fractures occur frequently in the elderly population over the age of 60 years following low-energy domestic falls. The postoperative mortality after hip fracture surgery depends on numerous factors like comorbidities, pre-fall ambulatory status, nutritional status, cognition, and overall physical health. In this context, the physiological age and reserve play a vital role in mortality after hip fracture surgeries. This physiological reserve is measured in terms of "frailty." There are many frailty indices that assess the physiological reserves of an elderly patient. The modified frailty index (MFI) is one of the validated indexes predicting postoperative complications and mortality. So we concluded there is a need to assess the patients with MFI preoperatively, based on which mortality and postoperative complications could be predicted in our patients. Materials and methodsWe included 100 patients aged more than 60 years with intertrochanteric and neck of the femur fractures, who were managed surgically. We followed the patients for one year and observed the immediate and late complications and mortality at the end of one year. To reduce bias, patients with pathological fractures, revision surgeries, contralateral fractures, high-energy trauma, younger than 60 years of age, and previous proximal femur fracture surgery on the side of injury were excluded from the study. ResultsThe primary objective was to study the correlation between the MFI with one-year mortality. We observe that the MFI score had a significant effect on mortality at one year (p-value = 0.0316). With a unit increase in the MFI score, the odds of death increase by a factor of 1.52. ConclusionThere is a strong correlation between MFI with one-year mortality and postoperative complications after hip fracture surgeries in the elderly. This MFI can be used as a preoperative predictive model to predict the mortality and postoperative complications after hip fractures in the elderly. It will also help patients and their caretakers in decision-making and elucidating surgery choices.

New Perianal Sepsis Risk Score Predicts Outcome of Elderly Patients with Perianal Abscesses

“…Our data suggest that the etiology and bacteriology of perianal abscesses in elderly patients differ from the disease in younger patients. However, as is known from other surgical interventions [ 17 , 18 , 19 , 20 , 21 , 22 ], our data also reveal that the frailty status of aged people—and not their chronological age—mainly determines the outcome in both the short as well as longer term after surgery for perianal abscesses. These findings are the expression of the multidimensional frailty syndrome, which involves physiological and psychological aspects and results in loss of functional reserve and increased vulnerability upon surgery, as stated recently by Cappe et al [ 18 ].…”

“…It is known from other formally trivial diseases in general surgery, that elderly patients are at higher risk for experiencing a more severe and complicated course [ 17 ]. However, it is less the chronologic age than the multidimensional frailty syndrome, which dramatically increases the risk for poor outcome and consecutively for additional resource utilization after various elective and urgent surgical interventions [ 17 , 18 , 19 , 20 , 21 , 22 ]. This is currently unknown for patients with perianal abscesses, thus further research is needed to investigate this relevant issue in more detail.…”