Authors: Kushal V Patel Kindyle L Brennan Michael L Brennan Daniel C Jupiter Adam Shar Matthew L Davis
Publish Date: 2013/10/29
Volume: 472, Issue: 3, Pages: 1010-1017
Abstract
Frailty a multidimensional syndrome entailing loss of energy physical ability cognition and health plays a significant role in elderly morbidity and mortality No study has examined frailty in relation to mortality after femoral neck fractures in elderly patientsWe examined the association of a modified frailty index abbreviated from the Canadian Study of Health and Aging Frailty Index to 1 and 2year mortality rates after a femoral neck fracture Specifically we examined 1 Is there an association of a modified frailty index with 1 and 2year mortality rates in patients aged 60 years and older who sustain a lowenergy femoral neck fracture 2 Do the receiver operating characteristic ROC curves indicate that the modified frailty index can be a potential tool predictive of mortality and does a specific modified frailty index value demonstrate increased odds ratio for mortality 3 Do any of the individual clinical deficits comprising the modified frailty index independently associate with mortalityWe retrospectively reviewed 697 lowenergy femoral neck fractures in patients aged 60 years and older at our Level I trauma center from 2005 to 2009 A total of 218 31 patients with highenergy or pathologic fracture postoperative complication including infection or revision surgery fracture of the contralateral hip or missing documented mobility status were excluded The remaining 481 patients with a mean age of 812 years were included Mortality data were obtained from a state vital statistics department using date of birth and Social Security numbers Statistical analysis included unequal variance ttest Pearson correlation of age and frailty ROC curves and area under the curve HosmerLemeshow statistics and logistic regression modelsOneyear mortality analysis found the mean modified frailty index was higher in patients who died 46 ± 18 than in those who lived 30 ± 2 p 0001 which was maintained in a 2year mortality analysis 44 ± 18 versus 30 ± 2 p 0001 In ROC analysis the area under the curve was 074 and 072 for 1 and 2year mortality respectively Patients with a modified frailty index of 4 or greater had an odds ratio of 497 for 1year mortality and an odds ratio of 401 for 2year mortality as compared with patients with less than 4 Logistic regression models demonstrated that the clinical deficits of mobility respiratory renal malignancy thyroid and impaired cognition were independently associated with 1 and 2year mortalityPatients aged 60 years and older sustaining a femoral neck fracture with a higher modified frailty index had increased 1 and 2year mortality rates and the ROC analysis suggests that this tool may be predictive of mortality Patients with a modified frailty index of 4 or greater have increased risk for mortality at 1 and 2 years Clinical deficits of mobility respiratory renal malignancy thyroid and impaired cognition also may be independently associated with mortality The modified frailty index may be a useful tool in predicting mortality guiding patient and family expectations and elucidating implant/surgery choices Further prospective studies are necessary to strengthen the predictive power of the indexEach author certifies that he or she or a member of his or her immediate family has no commercial associations eg consultancies stock ownership equity interest patent/licensing arrangements etc that might pose a conflict of interest in connection with the submitted articleEach author certifies that his or her institution approved the human protocol for this investigation all investigations were conducted in conformity with ethical principles of research and informed consent for participation in the study was obtained
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