Predictive scoring system for independent walking disability after fragility hip fracture surgery: a multicenter...

Loss of walking ability after hip fracture in older adults is associated with increased morbidity and mortality. To address this, we developed and internally validated a predictive scoring system to estimate the risk of independent walking disability at three months postoperatively. This multicenter retrospective cohort study included 740 patients aged 60 years or older who underwent surgery for fragility hip fracture. Twelve clinically relevant predictors were initially assessed, and multivariable logistic regression with backward elimination identified nine variables for the final model. A point-based scoring system (total score range 0-16) was constructed and validated using 500 bootstrap resamples. At three months, 113 patients (15.3%) were unable to walk independently, while 627 (84.7%) regained independent ambulation. The model demonstrated good discrimination (area under the receiver operating characteristic curve (AuROC) of 0.81) and good calibration (calibration slope of 1.008; calibration-in-the-large (CITL) of -0.002). Based on calibration performance and score distribution, patients were stratified into three risk categories: low risk (score 0-5), moderate risk (score 6-14), and high risk (score 15-16), with positive predictive values for walking disability of 1.8%, 19.1%, and 60.0%, respectively. Mean total scores differed significantly between groups (11.7 ± 3.0 vs. 7.2 ± 3.9, p < 0.001). This scoring system provides a practical tool for postoperative risk stratification prior to hospital discharge, facilitating discharge planning and individualized rehabilitation strategies. It may be particularly useful for identifying high-risk patients who could benefit from tailored post-discharge rehabilitation programs in the home setting.