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New Five-Factor Modified Frailty Index Predicts Morbidity and Mortality in Geriatric Hip Fractures

Traven, Sophia A. MD; Reeves, Russell A. MD; Althoff, Alyssa D. BS; Slone, Harris S. MD; Walton, Zeke J. MD

Journal of Orthopaedic Trauma: July 2019 - Volume 33 - Issue 7 - p 319–323
doi: 10.1097/BOT.0000000000001455
Original Article

Introduction: 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.

Methods: 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.

Results: 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%.

Conclusions: 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.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.

Reprints: Sophia A. Traven, MD, Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas Dr, CSB 708, Charleston, SC 29425 (e-mail:

The authors report no conflict of interest.

Accepted January 23, 2019

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