title: Impact of frailty on outcomes in geriatric femoral neck fracture management: An analysis of national surgical quality improvement program dataset.
abstract: BACKGROUND
  Frailty is a clinical state of increased vulnerability resulting from aging-associated decline in physiologic reserve. Hip fractures are serious fall injuries that affect our aging population. We retrospectively sought to study the effect of frailty on postoperative outcomes after Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) for femoral neck fracture in a national data set.
  
  
  METHODS
  National Surgical Quality Improvement Project dataset (NSQIP) was queried to identify THA and HA for a primary diagnosis femoral neck fracture using ICD-9 codes. Frailty was assessed using the modified frailty index (mFI) derived from the Canadian Study of Health and Aging. The primary outcome was 30-day mortality and secondary outcomes were 30-day morbidity and failure to rescue (FTR). We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for confounders.
  
  
  RESULTS
  Of 3121 patients, mean age of patients was 77.34 ± 9.8 years. The overall 30-day mortality was 6.4% (3.2%-THA and 7.2%-HA). One or more severe complications (Clavien-Dindo class-IV) occurred in 7.1% patients (6.7%-THA vs.7.2%-HA). Adjusted odds ratios (ORs) for mortality in the group with the higher than median frailty score were 2 (95%CI, 1.4-3.7) after HA and 3.9 (95%CI, 1.3-11.1) after THA. Similarly, in separate multivariate analysis for Clavien-Dindo Class-IV complications and failure to rescue 1.6 times (CI95% 1.15-2.25) and 2.1 times (CI95% 1.12-3.93) higher odds were noted in above median frailty group.
  
  
  CONCLUSIONS
  mFI is an independent predictor of mortality among patients undergoing HA and THA for femoral neck fracture beyond traditional risk factors such as age, ASA class, and other comorbidities.
  
  
  METHODS
  Level II.
authors.affiliation: Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; San Joaquin General Hospital, UC Davis, 500 W Hospital Rd, French Camp, CA 95231, USA. Electronic address: dayama.md@gmail.com.
authors.forename: Anand
authors.initials: A
authors.lastname: Dayama
authors.affiliation: Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Odunayo
authors.initials: O
authors.lastname: Olorunfemi
authors.affiliation: Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Greenbaum
authors.affiliation: Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Stone
authors.affiliation: Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: McNelis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000401:mortality; D066264:Datasets as Topic; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D016330:Frail Elderly; D006801:Humans; D007258:Informed Consent; D016015:Logistic Models; D008297:Male; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Femoral neck fractures; Frailty; NSQIP; Total hip arthroplasty and hemiarthroplasty; Trauma