Long-term survival in frail older adults sustaining a hip fracture: does the perioperative period really matter?

Purpose. Hip fractures in older adults are a major challenge for public health, it is associated with increased morbidity and mortality, especially in frailty older adults. An accurate evaluation of preventable perioperative risk factors is essential to optimize care pathways and clinical outcomes. This study aims to gauge evidence on the predictive accuracy of perioperative variables, including the Nottingham Hip Fracture Score (NHFS), on overall long-term survival (OS) in frail, hospitalized hip-fractured older adults. Methods. From March 2020 to September 2021, 433 elderly patients with hip fractures received multidisciplinary orthogeriatric care in Policlinic San Martino Hospital (Genova, Italy). Enrolled patients received geriatric assessment (CGA) within 24 hours from hospital admission and their medical conditions were assessed alongside post-operative complications and survival rates. Statistical analyses, including Cox models, evaluated factor influencing overall survival. Results. The patients’ most prevalent clinical phenotype was frailty, sustained by loss of muscle strength, malnutrition and functional disability. This phenotype reflects the unique demographic of the Liguria region (Italy) with the highest proportion of oldest-old (≥ 85 years) and frail individuals in the nation. Results showed NHFS > 5, vitamin D deficiency and delayed verticalization as key predictive determinants of long-term mortality (up to 21 months). Resilience to perioperative stressors in frail hip-fractured patients is crucial to the success of treatments aimed at improving their physical recovery. Conclusions. Our research showed that targeting preventable factors during surgery can greatly impact the functional reserve of frail elderly patients, influencing their recovery and long-term outcomes, including mortality rates.