What question did this study set out to answer?

This study aims to assess the effectiveness of mobile frailty apps and the PRISMA-7 questionnaire in predicting short-term mortality in elderly surgical patients.

March 25, 2026Open Access

A Prospective Observational Study to Find the Prognostic Utility of Mobile Frailty Apps and PRISMA-7 Questionnaire versus the American Society of Anesthesiologists Physical Score as Predictors of Mortality in Patients over 65 Years Undergoing Orthopedic Surgery for Fragility Fractures

Key Result

The Frailty Predictor app and PRISMA-7 questionnaire demonstrated the highest predictive accuracy for 1-month (AUC 0.832) and 3-month (AUC 0.862) mortality, outperforming ASA Physical Status.

Key Points

This study aims to assess the effectiveness of mobile frailty apps and the PRISMA-7 questionnaire in predicting short-term mortality in elderly surgical patients.
Conducted a prospective observational study involving 106 patients aged over 65 years undergoing orthopedic surgery for fragility fractures.
Utilized frailty assessments through the Clinical Frailty Scale, Frailty Predictor app, and PRISMA-7 questionnaire prior to surgery.
Documented the American Society of Anesthesiologists Physical Status for each participant and performed follow-up for 3 months.
18 patients (17%) died within 1 month post-surgery, and 21 patients (19.8%) died within 3 months.
Area under the curve for mortality prediction at 1 month was highest for FP (0.832), followed by PRISMA-7 (0.816), CFS (0.806), and lowest for ASA PS (0.659).
Mortality prediction at 3 months was highest for PRISMA-7 (0.862), followed by CFS (0.838), FP (0.831), and ASA PS (0.694).

Structured PICO

Do frailty assessment tools (CFS, FP, PRISMA-7) improve the prediction of 1- and 3-month mortality compared to ASA PS in patients over 65 years undergoing orthopedic surgery for fragility fractures?

Population

106 patients over 65 years undergoing orthopedic surgery for fragility fractures (proximal femur, proximal humerus, or distal radius)

Intervention

Frailty assessment using Clinical Frailty Scale (CFS) app, Frailty Predictor (FP) app, and PRISMA-7 questionnaire

Comparator

American Society of Anesthesiologists (ASA) Physical Status score

Outcome

Accuracy of the scores of CFS, FP, PRISMA-7, and ASA PS in predicting 1- and 3-month mortality postoperativelyhard clinical

Mobile frailty apps and the PRISMA-7 questionnaire demonstrate superior prognostic utility compared to the ASA Physical Status score for predicting short-term mortality in older adults undergoing surgery for fragility fractures.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background and Aims: Frailty is not routinely assessed in preanesthetic checkups. The present study evaluated the clinical utility of easy to use, free frailty apps on Android phones, and the Clinical Frailty Scale (CFS), the Frailty Predictor (FP), and a questionnaire, the PRISMA-7 with the American Society of Anesthesiologists (ASA) Physical Status (PS) to predict 1- and 3-month mortality of patients over 65 years undergoing surgery for fragility fractures (proximal femur, proximal humerus, or distal radius). Methods: This prospective study included 106 patients over 65 years who underwent surgery for fragility fractures. We got clearance from the Institutional Ethics Committee and registered the study with a national database. Frailty was assessed during the pre-anaesthetic check-up of all patients using the Clinical Frailty Scale (CFS)app, the Frailty Predictor (FP)app and the PRISMA-7 questionnaire, and the ASA Physical Status (ASA-PS) was documented. The patients were then followed up for 3 months. The study’s primary outcome was the accuracy of the scores of CFS, FP, PRISMA-7, and ASA PS in predicting 1- and 3-month mortality of the patients postoperatively. Results: Of 106 patients who completed the study, a total of 18 were deceased at 1 month (17%), and 21 were deceased at 3 months (19.8%). The area under the curve (AUC) of CFS, FP, PRISMA-7, and ASA PS for mortality at 1 month after surgery was 0.806, 0.832, 0.816, and 0.659, respectively. The AUC of CFS, FP, PRISMA-7, and ASA PS for mortality at 3 months after surgery was 0.838, 0.831, 0.862, and 0.694, respectively. Conclusion: The predictive ability for 1-month postoperative mortality in frail patients over 65 years is highest for FP, followed by PRISMA-7, CFS, and ASA PS. The predictive ability for 3-month postoperative mortality is highest for PRISMA-7, followed by CFS, FP, and ASA PS.