Adverse outcomes following pelvic fracture: the critical role of frailty

Abstract

Purpose Pelvic fractures among older adults are associated with an increased risk of adverse outcomes, with frailty likely being a contributing factor. The current study endeavors to describe the association between frailty, measured using the Orthopedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients. Methods All geriatric (65 years or older) patients registered in the 2013–2019 Trauma Quality Improvement Program database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the pelvis with a lower extremity AIS ≥ 2, any abdomen AIS, and an AIS ≤ 1 in all other regions. Poisson regression models were employed to determine the association between the OFS and adverse outcomes. Results A total of 66,404 patients were included for further analysis. 52% (N = 34,292) were classified as non-frail (OFS 0), 32% (N = 21,467) were pre-frail (OFS 1), and 16% (N = 10,645) were classified as frail (OFS ≥ 2). Compared to non-frail patients, frail patients exhibited a 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54–2.30), p < 0.001], a 25% increased risk of complications [adjusted IRR (95% CI): 1.25 (1.10–1.42), p < 0.001], a 56% increased risk of failure-to-rescue [adjusted IRR (95% CI): 1.56 (1.14–2.14), p = 0.006], and a 10% increased risk of ICU admission [adjusted IRR (95% CI): 1.10 (1.02–1.18), p = 0.014]. Conclusion Frail pelvic fracture patients suffer from a disproportionately increased risk of mortality, complications, failure-to-rescue, and ICU admission. Additional measures are required to mitigate adverse events in this vulnerable patient population.

Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures

“…Furthermore, the laterality and location of the rib fractures could not be accurately determined for all patients, as a result of the structure of the dataset. While the OFS was initially developed for patients with hip fracture, 14 15 the findings of subsequent research including the current investigation suggest that it can be applied to other trauma populations with fractures, 16 and may be a useful tool for assessing frailty and guiding clinical decision-making.…”

“…Recently, a novel frailty score, the Orthopedic Frailty Score (OFS), consisting of five readily available variables at the time of admission, has been developed and validated in orthopedic patients who experienced traumatic fractures. [14][15][16] In the current study, we set out to investigate the relationship between the OFS and adverse outcomes in geriatric patients with conservatively managed isolated rib fractures.…”

The pathophysiology of pelvic ring injuries: a review

“…Traumatic disruptions of the pelvic ring result from high-energy trauma mechanisms and represent a major source of life-threatening hemorrhage and potentially preventable mortality in young trauma patients [ 1 – 3 ]. Physiologic instability can also result from low-energy pelvic ring injuries in elderly patients with poor quality bone stock [ 4 ]. The main root cause of the high mortality around 30-40% in the modern literature is due to the underrecognized presence of exsanguinating hemorrhage and “hidden shock” from occult bleeding sources in the retroperitoneal space [ 5 – 9 ].…”