Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?
Aims: The aim of this study was to analyze the risk of mortality and other postoperative complications following restricted weightbearing in geriatric patients who undergo fixation of a hip fracture, while accurately controlling for patient frailty. Methods: The National Surgical Quality Improvement...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2025-07-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.67.BJO-2025-0059.R1 |
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| author | Makoa Mau Tyler Thorne Kai Rossbach Eleanor H. Sato Chong Zhang Angela P. Presson Justin M. Haller |
| author_facet | Makoa Mau Tyler Thorne Kai Rossbach Eleanor H. Sato Chong Zhang Angela P. Presson Justin M. Haller |
| author_sort | Makoa Mau |
| collection | DOAJ |
| description | Aims: The aim of this study was to analyze the risk of mortality and other postoperative complications following restricted weightbearing in geriatric patients who undergo fixation of a hip fracture, while accurately controlling for patient frailty. Methods: The National Surgical Quality Improvement Program (NSQIP) database January 2016 to December 2020 was queried for operatively treated hip fractures in patients aged ≥ 60 years using Current Procedural Terminology (CPT) codes (n = 53,959). Logistic regressions and receiver operating characteristic (ROC) curve analysis were conducted to determine the frailty measure which best predicts 30-day mortality among American Society of Anesthesiologists grade (ASA), five-factor modified Fraility Index (mFI-5), and Risk Analysis Index Recalibrated Version (RAI-Rev). The effect of weightbearing on 30-day mortality, and severe (SAE) and minor (MAE) adverse events, was assessed using logistic regressions while controlling for the selected frailty measure and other relevant patient characteristics. Results: A total of 53,959 patients met the inclusion criteria, and 36,177 patients (67%) were weightbearing as tolerated postoperatively. Under ROC curve, the only discriminatory performance was by RAI-Rev in 30-day mortality. Controlling for RAI-Rev, age, sex, BMI, functional status, and CPT, weightbearing patients had a 42% lower odds of 30-day mortality (p < 0.001), a 31% lower odds of a SAE (p < 0.001), and a 24% lower odds of a MAE (p < 0.001) in comparison to non-weightbearing patients. Conclusion: Geriatric hip fractures are prevalent in patients with varying degrees of health. RAI-Rev is a better predictor of postoperative mortality than ASA grade and mFI-5, and should be used in evaluating the risk of geriatric hip fractures. Postoperative weightbearing is associated with significant reductions in complications for geriatric hip fracture patients, even while controlling for frailty. Our findings suggest that postoperative weightbearing after surgical fixation of geriatric hip fractures should be encouraged for able patients. Cite this article: Bone Jt Open 2025;6(7):785–795. |
| format | Article |
| id | doaj-art-d141095941dd45e59ff6bd6354eae2b1 |
| institution | Kabale University |
| issn | 2633-1462 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj-art-d141095941dd45e59ff6bd6354eae2b12025-08-20T03:34:47ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622025-07-016778579510.1302/2633-1462.67.BJO-2025-0059.R1Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?Makoa Mau0Tyler Thorne1Kai Rossbach2Eleanor H. Sato3Chong Zhang4Angela P. Presson5Justin M. Haller6Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USADepartment of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USADepartment of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USADepartment of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USADivision Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USADivision Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USADepartment of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USAAims: The aim of this study was to analyze the risk of mortality and other postoperative complications following restricted weightbearing in geriatric patients who undergo fixation of a hip fracture, while accurately controlling for patient frailty. Methods: The National Surgical Quality Improvement Program (NSQIP) database January 2016 to December 2020 was queried for operatively treated hip fractures in patients aged ≥ 60 years using Current Procedural Terminology (CPT) codes (n = 53,959). Logistic regressions and receiver operating characteristic (ROC) curve analysis were conducted to determine the frailty measure which best predicts 30-day mortality among American Society of Anesthesiologists grade (ASA), five-factor modified Fraility Index (mFI-5), and Risk Analysis Index Recalibrated Version (RAI-Rev). The effect of weightbearing on 30-day mortality, and severe (SAE) and minor (MAE) adverse events, was assessed using logistic regressions while controlling for the selected frailty measure and other relevant patient characteristics. Results: A total of 53,959 patients met the inclusion criteria, and 36,177 patients (67%) were weightbearing as tolerated postoperatively. Under ROC curve, the only discriminatory performance was by RAI-Rev in 30-day mortality. Controlling for RAI-Rev, age, sex, BMI, functional status, and CPT, weightbearing patients had a 42% lower odds of 30-day mortality (p < 0.001), a 31% lower odds of a SAE (p < 0.001), and a 24% lower odds of a MAE (p < 0.001) in comparison to non-weightbearing patients. Conclusion: Geriatric hip fractures are prevalent in patients with varying degrees of health. RAI-Rev is a better predictor of postoperative mortality than ASA grade and mFI-5, and should be used in evaluating the risk of geriatric hip fractures. Postoperative weightbearing is associated with significant reductions in complications for geriatric hip fracture patients, even while controlling for frailty. Our findings suggest that postoperative weightbearing after surgical fixation of geriatric hip fractures should be encouraged for able patients. Cite this article: Bone Jt Open 2025;6(7):785–795.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.67.BJO-2025-0059.R1hip fractureweightbearingtraumageriatricfrailtymortalitynsqiphip fracturesfrailtyanesthesiologistsgeriatric hip fracturesbmilogistic regressionspostoperative complicationssurgical fixationother complicationsdeep vein thrombosis (dvt) |
| spellingShingle | Makoa Mau Tyler Thorne Kai Rossbach Eleanor H. Sato Chong Zhang Angela P. Presson Justin M. Haller Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty? Bone & Joint Open hip fracture weightbearing trauma geriatric frailty mortality nsqip hip fractures frailty anesthesiologists geriatric hip fractures bmi logistic regressions postoperative complications surgical fixation other complications deep vein thrombosis (dvt) |
| title | Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty? |
| title_full | Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty? |
| title_fullStr | Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty? |
| title_full_unstemmed | Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty? |
| title_short | Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty? |
| title_sort | does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty |
| topic | hip fracture weightbearing trauma geriatric frailty mortality nsqip hip fractures frailty anesthesiologists geriatric hip fractures bmi logistic regressions postoperative complications surgical fixation other complications deep vein thrombosis (dvt) |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.67.BJO-2025-0059.R1 |
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