Introduction: Hip fracture is expensive in terms of mortality, hospital length of stay (LOS) and consequences for independence. Poor outcome reflects the frailty of the patients who typically sustain this injury, but the impact of different comorbidities and impairments is complex to understand. We consider this in a prospective cohort study designed to examine how patients' Frailty index (FI) predicts outcome.
Method: We assessed sequential patients admitted with low trauma hip fracture, excluding only those unfit for surgery. National Hip Fracture Database data were supplemented with a 51 point FI derived from Comprehensive Geriatric Assessment (CGA) findings.
Results: We describe 178 patients; mean age 81 years, 73.5% female. The mean FI was 0.34 (SD = 0.16), and logistic regression identified AMT score and FI as the strongest predictors of poor outcome. When patients were stratified by FI, 56 (31.5%) were in the low-frailty group (FI ≤0.25), 58 (32.5%) in intermediate (FI >0.25–0.4) and 64 (36%) in the high-FI group (FI >0.4). All the patients in the low-FI group returned to their original residence, 80% by 30 days (mean 21.6 days) with no inpatient deaths. The mean LOS for the intermediate group was 36.3 days compared with 67.8 days in the high FI group (P < 0.01). Thirty-day mortality was 3.4% for the intermediate group, compared with 17.2% for the high FI group (P < 0.001).
Conclusion: Individual CGA findings proved disappointing as outcome predictors, while the FI proved effective in integrating assessment results to make useful predictions of LOS, of the likelihood of successful return home, and of mortality in the first 30 days.