Impact of frailty and comorbidity index on postoperative complications and functional outcomes among elderly patients undergoing hip fracture surgeries under regional anesthesia techniques

Abstract

Background & Objective: Elderly patients sustaining hip fractures often are physically very frail and have multiple co-morbidities that might significantly affect their clinical outcomes after surgery. We evaluated the effect of frailty and co-morbidities on the functional outcomes, morbidity and mortality among elderly patients undergoing hip fracture surgeries under regional anesthesia.

Methodology: Elderly patients who underwent hip fracture surgeries under regional anesthesia between 1 April 2021 to 30 April 2022 were included in this non-concurrent cohort study. Besides basic demographic and perioperative data, the Charlson Comorbidity Index (CCI), length of hospital stay, length of ICU stay and 30-day readmission rates were noted. Telephonic interviews were conducted at 3 months following surgery and a note was made of their pre-operative Clinical Frailty Score (CFS), ability to walk within 3 months of discharge, Activities of Daily Living (ADL) using Katz Index (KI) and 90-day mortality.

Results: Of the 109 patients included in the final analysis, forty belonged to the prefrail and sixty-nine to the frail group. Forty-five had moderate CCI while sixty-four belonged to severe CCI. Patients with severe co-morbidities had a significantly lower KI score (P = 0.023) and longer length of ICU stay (P = 0.005). Frail patients had significantly higher mortality rates at 30, 60 and 90 days compared to prefrail, (mortality at 30-days P = 0.029, 60-days P = 0.006, 90-days P < 0.001)

Conclusions: Presence of Frailty and multiple co-morbidities result in significantly worse outcomes (both mortality and functional outcomes) among elderly patients undergoing hip fracture surgeries. This underlines the importance of routine assessment of frailty and CCI scores during preoperative screening.

Abbreviations: ADL - Activities of daily living; CCI - Charlson Comorbidity Index; CFS - Clinical Frailty Score; ICU – Intensive Care Unit; KI - Katz Index; MI - Myocardial Infarction

Key words: Hip Fracture; Elderly; Frailty; Comorbidity; Mortality; Functional Outcome; Clinical Frailty Scale; Charlson Comorbidity Index

Citation: Mathew A, Lukachan GA, Varughese D, Raju N, Mathai AS, Johnson AS. Impact of frailty and comorbidity index on postoperative complications and functional outcomes among elderly patients undergoing hip fracture surgeries under regional anesthesia techniques. Anaesth. pain intensive care 2023;27(2):161−169; DOI: 10.35975/apic.v27i2.2132

Received: January 16, 2023; Reviewed: February 19, 2023; Accepted: February 28, 2023