Association of preoperative modified frailty Index-5 with 30-day mortality and complications in elderly hip fracture...

Frailty is an established predictor of adverse outcomes during surgical procedures in the elderly. Despite this, the prognostic utility of the mFI-5 for early mortality and postoperative complications remains poorly characterised in this population, particularly among those who underwent surgical procedures for hip fracture.

This prospective observational study was performed in a single tertiary care hospital in South India from 2023 to 2024. Patients aged 60 years and above who underwent surgical management for fracture of neck of femur or intertrochanteric fracture were eligible for inclusion. Primary outcome measure was 30-day mortality. Secondary outcomes included risk of surgical site infection, Clavien-Dindo class IV complications, presence of any complication, risk of recurrent hospital admissions, and prolonged duration of hospital admission for more than 14 days. Outcomes were evaluated relative to mFI-5 scores ≤2 and > 2.

The sample size comprised 200 participants (average age 74.6 ± 9.11 years; 54% female), with a complete 30-day follow-up. 30.5% had an mFI-5 score of 0, 31% had one, 27% had two, and 11.5% had an mFI-5 score >2. Receiver operating characteristic analysis for 30-day mortality demonstrated an AUC of 0.850 (95% CI 0.730-0.969; p < 0.001). An mFI-5 score >2 demonstrated 63.6% sensitivity and 91.5% specificity. Participants with mFI-5 >2 had significantly higher odds of 30-day mortality (OR 18.90, 95% CI 5.00-71.60; p < 0.001). Scores >2 were also associated with higher odds of readmission, complications (including Clavien-Dindo IV), surgical site infection, and prolonged hospital stay (>14 days) (all p ≤ 0.013).

Higher mFI-5 scores were associated with increased 30-day mortality risk and post-surgical complications in elderly patients undergoing hip fracture surgery.