Maximilian Peter Forssten (Örebro / SE), Ahmad Mohammad Ismail (Örebro / SE), Ioannis Ioannidis (Örebro / SE), Per Wretenberg (Örebro / SE), Tomas Borg (Örebro / SE), Yang Cao (Örebro / SE), Marcelo Augusto Fontenelle Jr Ribeiro (Abu Dhabi / AE), Shahin Mohseni (Örebro / SE)
Abstract text (incl. references and figure legends)
Introduction
Frailty is a condition characterized by a reduced ability to adapt to external stressors because of a reduced physiologic reserve, which contributes to the high risk of postoperative mortality following hip fracture surgery. This study aims to investigate how frailty is associated with the specific causes of mortality in hip fracture patients.
Material & Methods
All adult patients in Sweden who suffered a traumatic hip fracture and underwent surgery between 2008 and 2017 were eligible for inclusion. The Orthopedic Hip Frailty Score (OFS) was used to classify patients as non-frail (OFS 0), pre-frail (OFS 1), and frail (OFS ≥2). The association between the degree of frailty and both all-cause and cause-specific mortality was determined using Poisson regression models with robust standard errors while adjusting for potential confounders.
Results
After applying the inclusion and exclusion criteria, 127,305 patients remained for further analysis. 24% of patients were non-frail, 28% were pre-frail, and 48% were frail. Frail patients exhibited an almost 4-fold higher risk of all-cause mortality 30 days postoperatively [adjusted incidence rate ratio (adj. IRR) and 95% confidence interval (CI): 3.8 (3.4-4.3), p<0.001] and 90 days postoperatively [adj. IRR (95% CI): 3.9 (3.6-4.2), p <0.001], compared to non-frail patients. Of the primary cause of 30-day mortality, frailty was associated with a 3.2 times higher risk of cardiovascular mortality [adj. IRR (95% CI): 3.2 (2.6- 4.0), p<0.001], a 2.6 times higher risk of respiratory mortality [adj. IRR (95% CI): 2.6 (2.0- 3.5), p<0.001], and a 5.0 times higher risk of multiorgan failure [adj. IRR (95% CI): 5.0 (4.0- 6.3), p<0.001].
Conclusion
Frailty is associated with a significantly increased risk of all-cause and cause-specific mortality at 30 and 90 days postoperatively. Across both timepoints, cardiovascular and respiratory events along with multiorgan failure were the most prevalent causes of mortality.
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