It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

Abstract

Background Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients. Methods This is a secondary analysis of the American Association of Surgery for Trauma Frailty Multi-institutional Trial. Patients ≥65 years presenting to one of the 17 trauma centers over 3 years (2019-2022) were included. Frailty was assessed within 24 hours of presentation using the trauma-specific frailty index (TSFI) questionnaire. Patients were stratified by TSFI score into six groups: non-frail (<0.12), Grade I (0.12-0.19), Grade II (0.20-0.29), Grade III (0.30-0.39), Grade IV (0.40-0.49), and Grade V (0.50-1). Our Outcomes included in-hospital and 3-month post-discharge mortality, major complications, readmissions, and fall recurrence. Multivariable regression analyses were performed. Results 1,321 patients were identified. The mean (SD) age was 77 (8.6) years and 49% were males. Median [IQR] ISS was 9[5-13] and 69% presented after a low-level fall. Overall, 14% developed major complications and 5% died during the index admission. Among survivors, 1,116 patients had a complete follow-up, 16% were readmitted within 3 months, 6% had a fall recurrence, 7% had a complication, and 2% died within 3 months post-discharge. On multivariable regression, every 0.1 increase in the TSFI score was independently associated with higher odds of index-admission mortality and major complications, and 3 months post-discharge mortality, readmissions, major complications, and fall recurrence. Conclusions The frailty syndrome goes beyond a binary stratification of patients into Non-Frail and Frail and should be considered as a spectrum of increasing vulnerability to poor outcomes. Frailty scoring can be used in developing guidelines, patient management, prognostication, and care discussions with patients and their families. Level of Evidence Level III, Prognostic and Epidemiological

Beyond Mortality: Severely Frail Femur Fracture Patients Can Regain Independence after Surgery

“…The prior literature has focused on post-operative complications and mortality, neglecting the long-term functional outcomes of these patients [25][26][27]. This cohort of 37 femoral fracture patients living with severe frailty, which mirrors Jones et al's distribution of frailty [18] and prior reported OGC care teams' target populations, demonstrates that while there is a high rate of 1-year mortality following surgical treatment of femur fractures, at the best point of recovery patients report overall positive outcomes in terms of freedom from pain, ambulatory ability, functional independence, and social interaction [5,11,27,36,37].…”