Comparison of two frailty indexes in hip fractures

Abstract

Aim: Modified-Krishnan’s frailty index (FI) is an FI calculation method developed by Krishnan et al. in 2014. This study aimed to compare the effectiveness and correlation of the FIs from Krishnan and the Canadian study of health and aging (CSHA) in predicting postoperative outcomes of elderly patients with hip fracture. Methods: Based on clinical follow-up and observation, we utilized these two instruments to predict 3-month mortality, hip function, and recovery of daily activities. The area under the curve (AUC) and the Pearson correlation coefficient were used to compare the two scales’ predictive validities for postoperative outcomes. Results: A total of 130 patients were included; 67% female and mean age 77.5 ± 8.5 years. The AUCs of modified-Krishnan’s FI (AUC = 0.856; 95% confidence interval (CI) = 0.767–0.945) and the CSHA-FI (AUC = 0.793; 95% CI = 0.652–0.934) were used to compare the effectiveness in predicting patient mortality. The optimal predictive scores were 0.335 and 0.28, respectively. The Pearson correlation analysis showed that the modified-Krishnan’s FI correlated with the Japanese Orthopaedic Association hip score (pain, activity, walking ability, and ability for daily living; R = −0.249, p = 0.005), while the CSHA-FI was not correlated ( R = −0.125, p = 0.170). The modified-Krishnan’s FI ( R = −0.415, p < 0.001) and the CSHA-FI ( R = −0.332, p < 0.001) were both significantly correlated with the functional recovery scale score. Conclusions: The modified-Krishnan’s FI and the CSHA-FI were effective in the prediction of postoperative mortality. But the modified-Krishnan’s FI was more consistently associated with the recovery of hip function and daily activities at 3 months after the operation than that of the CSHA-FI. The modified-Krishnan’s FI was more suitable to utilize for risk stratification, identifying deficits, and predicting recovery capacity in hip fracture patients.

Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes

“…Many previous studies reported that frailty was a predictor of adverse outcomes. The clinical outcomes included mortality [70,71,[74][75][76][77]82,84], the occurrence of complications [72,73,78], length of hospital stay [72][73][74], ADL [78,80,81,83], QOL [79], and discharge disposition [72,74,78,83]. However, few well-designed studies were conducted.…”

Higher Charlson Comorbidity Index Increases 90-Day Readmission Rate with Poorer Functional Outcomes in Surgically Treated Hip Fracture Patients

“…[46][47][48] A number of geriatric studies have looked into the concept of frailty through a variety of frailty indexes such as the Chinese -Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) or modified Frailty Index (mFI-11) and the impact of frailty on healthcare outcomes. [49][50][51][52][53] These indexes act as comprehensive geriatric assessments covering frailtyrelated characteristics that briefly include activity level, presence of diseases or functional status. 51,52 A study by Chen et al in 2019 53 aimed to look into temporal association between frailty and adverse outcomes, showing frailty has long-term effects on 1-, 3-and 6-month mortality and readmissions.…”

Rehabilitation for Frail Patients With Hip Fracture

“…Accurately measuring frailty can help identify modifiable factors contributing to poor outcomes and select strategies that can optimize outcomes before the surgical repair. 17 Measuring frailty can also help in risk stratification. Identifying patients with hip fractures who also have frailty allows the identification of a higher-risk subset of the population.…”

“…13,14 Some studies have found that frailty doubles the risk of hip fracture. 15 Several studies have shown a significant association between frailty and worsened outcomes after hip fractures, such as increased length of stay, 16 more severe complications after surgery, 11 hip pain and slower functional recovery, 17 change of residence 1 month after hip fracture, 16 increased emergency visits 1 month post-fracture, 11 increased likelihood of hospital readmission 3 months post-fracture (eg, due to pulmonary complications), and even increased mortality. 12,[17][18][19]…”