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Validation of the orthopedic frailty score for measuring frailty in hip fracture patients: a cohort study based on the United States National inpatient sample
Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-3583-3443
Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology and Biostatistics.ORCID iD: 0000-0002-3552-9153
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedic Surgery.ORCID iD: 0000-0003-3436-1026
Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
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2023 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 49, no 5, p. 2155-2163Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc , 2023. Vol. 49, no 5, p. 2155-2163
Keywords [en]
Complication, Hip fracture, Mortality, Orthopedic frailty score, Risk stratification
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-106589DOI: 10.1007/s00068-023-02308-7ISI: 001014527600001PubMedID: 37349513Scopus ID: 2-s2.0-85163048995OAI: oai:DiVA.org:oru-106589DiVA, id: diva2:1775686
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Örebro UniversityAvailable from: 2023-06-27 Created: 2023-06-27 Last updated: 2024-03-06Bibliographically approved

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Forssten, Maximilian PeterCao, YangMohammad Ismail, AhmadIoannidis, IoannisMohseni, Shahin

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