Effect of frailty on clinical outcomes of hip fracture patients: A SYSTEMATIC REVIEW

Abstract

Objective: To determine the impact of frailty on clinical outcomes of hip fracture (HF) patients. Methods: Original studies published during the last 10 y were sear ched in PubMed and Cochrane using the key terms (frailty) AND (clinical outcomes OR adverse outcomes OR prognosis) AND (hip fracture OR femoral fracture). The PRISMA guidelines were fol lowed in selecting articles and case reports, conference reports, review articles, meta-analyses and articles published in other lan guages were excluded. Results: The original search retrieved in 117 articles. Based on selection criteria 13 quantitative studies (4 retrospective cohort studies, 6 prospective and 3 hospital databases) were considered covering 211,461 total HF patients aged C 50 y. These studies have used 10 different tools to assess frailty: those were Frailty index (including number of deficits such as 51, 44, 32, 22, 19 deficits), modified frailty index, Edmonton frailty scale, Clinical frailty scale, Groningen Frailty Index and Hospital frailty risk score. Clinical outcomes included six themes such as functional outcomes, medical complications, surgical complications, readmissions, length of hos pital stay and mortality at 1, 3, 6 months and 1 y post fracture. HF patients with higher degree of frailty had higher risk of short-term mortality, other medical and surgical complications, impaired func tional recovery, readmissions, increased length of hospital stay and impaired quality of life (QoL). Conclusion: HF patients with frailty experience more short-term mortality, adverse medical or surgical outcomes, impaired functional recovery and poor QoL compared with nonfrail patients. Frailty is a determinant of adverse clinical outcomes of HF patients