Gupta Nithin K, Chmait Hikmat R, Gill Vikram, Turnow Morgan, Manes Taylor, Taylor Benjamin C, Weick Jack W, Bowers Christian
Campbell University School of Osteopathic Medicine, Lillington, North Carolina.
REAM Orthopedics, Columbus, Ohio.
JAMA Netw Open. 2025 May 1;8(5):e2512689. doi: 10.1001/jamanetworkopen.2025.12689.
Hip fractures present a substantial public health challenge, with projections of more than 500 000 per year by 2040. As such, frailty indices such as the Revised Risk Analysis Index (RAI) and the Modified Five-Item Frailty Index (mFI-5) have been recently investigated as metrics for preoperative risk stratification for these patients.
To understand the accuracy of frailty, as measured by the RAI and the mFI-5, for estimating 30-day mortality following surgically managed hip fractures.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional analysis used the American College of Surgeons' National Surgical Quality Improvement database. Patients aged 65 years old with surgically managed traumatic hip fracture from 2015 to 2019 were included. Frailty was evaluated using the RAI, a 5-domain scale with 14 weighted variables graded from 0 to 81, and the mFI-5, a 2-domain scale with 5 unweighted variables graded from 0 to 5; for both, a higher score denotes worse frailty. Data collection occurred from May to June 2024.
Diagnosis of hip fracture and undergoing surgical fixation, hemiarthroplasty, or total hip arthroplasty.
The primary outcome was 30-day mortality. Multivariable regression was conducted to assess the estimating value of frailty scales. Discriminatory accuracy was assessed using a receiver operating characteristic curve and quantified using a C-statistic.
The cohort consisted of 114 359 patients (70 038 female [69.9%]; median [IQR] age, 84 [77-89] years) with 51 071 prefrail patients (44.7%) according to the mFI-5 and 31 883 very frail patients (27.9%) according to the RAI comprising the largest frailty groups. Increasing frailty status was associated with greater odds ratio (OR) for 30-day mortality for both the mFI-5 (prefrail OR, 1.35 [95% CI, 1.24-1.47]; frail OR, 2.11 [95% CI, 1.94-2.30]; severely frail OR, 3.53 [95% CI, 3.20-3.90]; P < .001 for all) and RAI (normal OR, 1.55 [95% CI, 1.35-1.79]; frail OR, 2.97 [95% CI, 2.59-3.42]; very frail OR, 6.17 [95% CI, 5.38-7.08]; P < .001 for all). The RAI demonstrated superior discriminatory accuracy for 30-day mortality compared with the mFI-5 (area under the receiver operating characteristic curve, 0.73 [95% CI, 0.72-0.73] vs 0.61 [95% CI, 0.60-0.62]; P < .001).
In this cross-sectional study of 114 359 patients, the RAI demonstrated superior odds and discriminatory accuracy for estimating 30-day mortality following surgical management of hip fractures. The RAI may be considered as a risk stratification tool for orthopedic surgeons to adjunct surgical planning, thereby reducing postoperative mortality.
髋部骨折给公共卫生带来了重大挑战，预计到2040年每年将超过50万例。因此，诸如修订风险分析指数（RAI）和改良五项衰弱指数（mFI-5）等衰弱指数最近已被研究作为这些患者术前风险分层的指标。
了解通过RAI和mFI-5测量的衰弱程度对于估计手术治疗髋部骨折后30天死亡率的准确性。
设计、设置和参与者：这项回顾性横断面分析使用了美国外科医师学会的国家外科质量改进数据库。纳入了2015年至2019年接受手术治疗创伤性髋部骨折的65岁及以上患者。使用RAI（一种5个领域的量表，有14个加权变量，评分从0到81）和mFI-5（一种2个领域的量表，有5个未加权变量，评分从0到5）评估衰弱程度；对于两者，分数越高表示衰弱越严重。数据收集于2024年5月至6月进行。
髋部骨折诊断以及接受手术固定、半髋关节置换术或全髋关节置换术。
主要结局是3０天死亡率。进行多变量回归以评估衰弱量表的估计价值。使用受试者工作特征曲线评估鉴别准确性，并使用C统计量进行量化。
该队列由114359名患者组成（70038名女性[69.9%]；年龄中位数[四分位间距]为84[77-89]岁），根据mFI-5有51071名衰弱前期患者（44.7%），根据RAI有31883名极度衰弱患者（27.9%），这两组是最大的衰弱群体。对于mFI-5（衰弱前期比值比，1.35[95%置信区间，1.24-1.47]；衰弱比值比，2.11[95%置信区间，1.94-2.30]；严重衰弱比值比，3.53[95%置信区间，3.20-3.90]；所有P<0.001）和RAI（正常比值比，1.55[95%置信区间，1.35-1.79]；衰弱比值比，2.97[95%置信区间，2.59-3.42]；极度衰弱比值比，6.17[95%置信区间，5.38-7.08]；所有P<0.001），衰弱程度增加均与30天死亡率的更高比值比相关。与mFI-5相比，RAI在30天死亡率的鉴别准确性方面表现更优（受试者工作特征曲线下面积，0.73[95%置信区间，0.72-0.73]对0.61[95%置信区间，0.60-0.62]；P<0.001）。
在这项对114359名患者的横断面研究中，RAI在估计手术治疗髋部骨折后30天死亡率方面表现出更高的比值比和鉴别准确性。RAI可被视为骨科医生辅助手术规划的风险分层工具，从而降低术后死亡率。
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