What is the clinical evidence from this study?

Study design: Cohort. Population: Hip fracture (n=245). Intervention: Frailty vs. Robust patients. Primary outcome: All-cause mortality at 6 months (HR 4.60, 95% CI 1.05-20.14, p=0.043).

December 13, 2019Open Access

Frailty is Associated with an Increased Risk of Major Adverse Outcomes in Elderly Patients Following Surgical Treatment of Hip Fracture

Key Result

Frail patients had a 4.6-fold higher risk of 6-month all-cause mortality compared to robust patients following surgical treatment for hip fracture (HR 4.60).

Study Design

Type

Cohort (n=245)

Multicenter

Yes

Structured PICO

Does frailty increase the risk of mortality, readmissions, and emergency department visits in patients aged 50 years or older following surgical treatment of hip fracture?

Population

245 older adults (mean age 78, 67.8% female) who underwent surgical treatment for hip fracture, followed for 6 months to assess the impact of frailty on adverse outcomes.

Exposure

Frailty and pre-frailty (assessed using the Chinese-Canadian Study of Health and Aging Clinical Frailty Scale)

Comparator

Robust patients (Levels 1-3 on the Clinical Frailty Scale)

Outcome

All-cause mortality at 1, 3, and 6 monthshard clinical

Frailty and pre-frailty are significant predictors of adverse outcomes, including mortality, readmission, and emergency department visits, in older adults up to 6 months after hip fracture surgery.

Main Result

Hazard Ratio: 4.6 (95% CI 1.05–20.14)

p-value: p=0.043

Limitations

Frailty assessment was based on the patient's or caregiver's subjective impression of premorbid functioning
Findings are representative of data from two institutions in the same county and may not generalize to other geographical areas
Effects of non-observable factors (e.g. caregiver issue) cannot be tested
Categorization and identification of frailty status were based on CSHA-CFS, not diagnostic interviews
Different clinical practices by hospitals could be explained by the global budget program and case payment system
Small effect sizes in the final model could be due to the small number of adverse outcomes

Abstract

We intended to explore the effect of level of frailty on, and relationship with, 1-, 3-, and 6-month postoperative emergency department visits, readmissions, and mortality. This is a prospective multicenter observational cohort study design. Patients aged 50 years or older treated for hip fracture (n = 245) were taken from Orthopedic wards in one medical center (n = 131) and one district hospital (n = 114) in Changhua County, Taiwan. Frailty was defined as measured by the validated Clinical Frailty Scale and categorized as robust, pre-frail, and frail. We used Kaplan-Meier analysis to estimate survival rates and Cox regression to estimate the risk of frailty associated with adverse outcomes. To examine the longitudinal associations between frailty and adverse outcome, the cross-lagged models were explored. Of the 245 patients, 55 (22.4%) were classified as frail, 113 (46.1%) as pre-frail, and 77 (31.4%) as robust. More cumulative events occurred for frail than for robust patients for each adverse outcome. Frailty has long-term effect on each adverse outcome after discharge, rather than the effect simultaneously. Targeting pre-frailty and frailty is essential for prevent adverse outcomes and improving the overall health of older adults after discharge for hip fracture.

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