Traven Sophia A, Reeves Russell A, Althoff Alyssa D, Slone Harris S, Walton Zeke J
Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.
J Orthop Trauma. 2019 Jul;33(7):319-323. doi: 10.1097/BOT.0000000000001455.
Although the 11-factor modified frailty index (mFI-11) has been shown to predict adverse outcomes in elderly patients undergoing surgery for hip fractures, the newer 5-factor index has not been evaluated in this population. The goal of this study is to evaluate the mFI-5 as a predictor of morbidity and mortality in elderly patients undergoing surgical management for hip fractures.
The NSQIP database was queried for patients 60 years of age and older who underwent surgical management for hip fractures between 2005 and 2016. The 5-factor score, which comprised diabetic status, history of COPD or current pneumonia, congestive heart failure, hypertension requiring medication, and nonindependent functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and 30-day postoperative complications.
A total of 58,603 patients were identified. After adjusting for comorbidities, the mFI-5 was a strong predictor for total complications, serious medical complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), surgical site infections, readmission, extended hospital length of stay, and mortality (P ≤ 0.008). For each point increase, the risk for any complication increased by 29.8%, serious medical complications 35.4%, surgical site infections 14.7%, readmission 24.6%, and mortality 33.7%.
The mFI-5 is an independent predictor of postoperative morbidity and mortality in elderly patients undergoing surgery for hip fractures. This clinical tool can be used by hospitals and surgeons to identify high-risk patients, accurately council patients and families with transparency, and guide perioperative care to optimize patient outcomes.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
尽管11因素改良虚弱指数（mFI-11）已被证明可预测老年髋部骨折手术患者的不良结局，但较新的5因素指数尚未在该人群中进行评估。本研究的目的是评估mFI-5作为老年髋部骨折手术治疗患者发病和死亡的预测指标。
查询NSQIP数据库，以获取2005年至2016年间接受髋部骨折手术治疗的60岁及以上患者。为每位患者计算由糖尿病状态、慢性阻塞性肺疾病史或当前肺炎、充血性心力衰竭、需要药物治疗的高血压以及非独立功能状态组成的5因素评分。使用多因素逻辑回归模型评估mFI-5与术后30天并发症之间的关系。
共识别出58603例患者。在调整合并症后，mFI-5是总并发症、严重医疗并发症（心脏骤停、心肌梗死、感染性休克、肺栓塞、术后透析、再次插管和延长呼吸机使用时间）、手术部位感染、再入院、延长住院时间和死亡率的强预测指标（P≤0.008）。每增加1分，任何并发症的风险增加29.8%，严重医疗并发症增加35.4%，手术部位感染增加14.7%，再入院增加24.6%，死亡率增加33.7%。
mFI-5是老年髋部骨折手术患者术后发病和死亡的独立预测指标。医院和外科医生可使用这一临床工具来识别高危患者，以透明的方式准确地向患者及其家属提供咨询，并指导围手术期护理以优化患者结局。
预后III级。有关证据水平的完整描述，请参阅作者指南。
