Frailty as defined by the comprehensive geriatric assessment frailty index (CGA-FI) is associated with in-hospital complications and mortality in geriatric hip fracture patients, A retrospective cohort study

Background Increased frailty is associated with higher rates of adverse events after hip fracture surgery. Unfortunately, considerable uncertainty remains about which tool or index best quantifies frailty and therefore the associated risk of complications following hip fracture surgery. This study tried to evaluate whether a Comprehensive Geriatric Assessment-Frailty Index could predict in-hospital complications following hip fracture surgery. Methods A retrospective cohort study was conducted among 1469 patients aged 70 years and older with an operatively managed hip fracture. Patients grouped according to their Comprehensive Geriatric Assessment-based Frailty Index: pre-frail to mildly frail and moderately to severely frail. The primary outcome was the occurrence of one or more complications. Secondary outcomes included specific complications, intensive care unit admission, length of stay and in-hospital mortality. Multivariable regression was used to adjust for confounders and presented as adjusted Odds Ratios (aOR). Results Moderately to severely frail was independently associated with an increased risk of having one or more complications (aOR 1.70, 95% CI=1.28–2.26, p < 0.001), urinary tract infection (aOR 2.12, 95% CI=1.01–4.47, p < 0.05), delirium (aOR 2.05, 95% CI=1.43–2.93, p < 0.001), in-hospital death (aOR 3.35, 95% CI=1.00–11.26, p = 0.05) and 1-year mortality (aOR 1.75, 95% CI=1.23–2.51, p = 0.002). Conclusion A Comprehensive Geriatric Assessment-based Frailty Index is a useful tool to predict in-hospital complications, in-hospital mortality and 1-year mortality in geriatric hip fracture patients. This tool provides useful information about a patient’s frailty, enables early risk stratification, and has the potential to support physicians, patients and healthcare proxies in shared decision-making and setting individualized postoperative expectations.