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- Title
Validation of the orthopedic frailty score for measuring frailty in hip fracture patients: a cohort study based on the United States National inpatient sample.
- Authors
Forssten, Maximilian Peter; Cao, Yang; Mohammad Ismail, Ahmad; Ioannidis, Ioannis; Tennakoon, Lakshika; Spain, David A.; Mohseni, Shahin
- Abstract
Background: The Orthopedic Frailty Score (OFS) has been proposed as a tool for measuring frailty in order to predict short-term postoperative mortality in hip fracture patients. This study aims to validate the OFS using a large national patient register to determine its relationship with adverse outcomes as well as length of stay and cost of hospital stay. Methods: All adult patients (18 years or older) registered in the 2019 National Inpatient Sample Database who underwent emergency hip fracture surgery following a traumatic fall were eligible for inclusion. The association between the OFS and mortality, complications, and failure-to-rescue (FTR) was determined using Poisson regression models adjusted for potential confounders. The relationship between the OFS and length of stay and cost of hospital stay was instead determined using a quantile regression model. Results: An estimated 227,850 cases met the study inclusion criteria. There was a stepwise increase in the rate of complications, mortality, and FTR for each additional point on the OFS. After adjusting for potential confounding, OFS 4 was associated with an almost ten-fold increase in the risk of in-hospital mortality [adjusted IRR (95% CI): 10.6 (4.02–27.7), p < 0.001], a 38% increased risk of complications [adjusted IRR (95% CI): 1.38 (1.03–1.85), p = 0.032], and an almost 11-fold increase in the risk of FTR [adjusted IRR (95% CI): 11.6 (4.36–30.9), p < 0.001], compared to OFS 0. Patients with OFS 4 also required a day and a half additional care [change in median length of stay (95% CI): 1.52 (0.97–2.08), p < 0.001] as well as cost approximately $5,200 more to manage [change in median cost of stay (95% CI): 5166 (1921–8411), p = 0.002], compared to those with OFS 0. Conclusion: Patients with an elevated OFS display a substantially increased risk of mortality, complications, and failure-to-rescue as well as a prolonged and more costly hospital stay.
- Subjects
LENGTH of stay in hospitals; FRAIL elderly; CONFIDENCE intervals; RESEARCH methodology evaluation; RESEARCH methodology; HIP fractures; MEDICAL care costs; HOSPITAL mortality; DESCRIPTIVE statistics; ADVERSE health care events; DISEASE risk factors; DISEASE complications
- Publication
European Journal of Trauma & Emergency Surgery, 2023, Vol 49, Issue 5, p2155
- ISSN
1863-9933
- Publication type
Article
- DOI
10.1007/s00068-023-02308-7