Role of Hip Multidimensional Frailty Score in the Management of Hip Fractures in Elderly Patients

Introduction: Periarticular hip fractures are common, debilitating injuries in elderly patients, often leading to high mortality rates and prolonged hospitalizations. With a projected increase in hip fractures worldwide, there is an urgent need for accurate preoperative tools to predict postoperative outcomes. The Hip Multidimensional Frailty Score (HMFS), which assesses frailty and physiological reserves, has shown promise in predicting complications in elderly patients with hip fractures. This study aims to validate the predictive value of the HMFS for mortality, postoperative complications, ICU need, and prolonged hospitalization in elderly hip fracture patients. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital, involving 100 elderly patients (age >60) with hip fractures (neck of femur and intertrochanteric fractures). Preoperative frailty was assessed using the HMFS, along with serum albumin levels. Postoperative outcomes, including ICU admission, complications, hospital stay, and 6-month mortality was studied. Results: The study revealed a significant association between the HMFS and postoperative outcomes. High HMFS (≥8) was linked to a 30.77% mortality rate, compared to 1.15% in patients with low HMFS (<8) (p<0.001). Additionally, 100% of high HMFS patients required ICU care, whereas only 18.4% of low HMFS patients did (p<0.001). Prolonged hospitalization (>5 days) was also associated with high HMFS (92.3% vs. 1.15%, p<0.01). Preoperative surgical delay (>1 day) was associated with a higher HMFS (mean 6.42 vs. 3.67, p<0.001) and increased 6-month mortality (15.8% vs. 2.5%, p<0.05). A significant correlation was observed between preoperative delay and 6-month mortality (Odds ratio 3.33, 95% CI 1.6-6.9). Conclusion: The Hip Multidimensional Frailty Score is a reliable tool for predicting mortality, ICU need, and hospital stay in elderly patients with hip fractures. High HMFS scores correlate with worse postoperative outcomes, including increased mortality and complications, and should be considered in preoperative decision-making. Additionally, reducing preoperative delay may improve outcomes, underscoring the importance of timely surgical intervention.