Frailty and adverse outcomes in periprosthetic femur fractures: a comparative analysis of risk stratification tools

Abstract Background Periprosthetic femur fractures are associated with substantial morbidity and mortality. The aim of the current study was to evaluate the association between frailty and adverse outcomes in geriatric patients with isolated periprosthetic femur fractures, as well as to compare the predictive performance of multiple risk stratification tools in this population. Methods Data were retrieved from the 2016–2021 ACS Trauma Quality Improvement Program dataset. All geriatric patients who suffered an isolated periprosthetic femur fracture due to a ground-level fall were eligible for inclusion. Frailty was measured using the Orthopedic Frailty Score (OFS). To determine the association between frailty and adverse outcomes, Poisson regression models with robust standard errors were employed. The ability of the OFS to predict mortality was compared to several other risk scores using the area under the receiver-operating characteristic curve (AUC). Results 1,220 patients with an isolated periprosthetic femur fracture were included in the analysis. After adjusting for potential confounders, frail patients exhibited a 204% higher risk of in-hospital mortality [RR (95% CI): 3.04 (1.05–8.81)], a 160% higher risk of complications [RR (95% CI): 2.60 (1.24–5.46)], and a 95% higher risk of ICU admission [RR (95% CI): 1.95 (1.11–3.43)], compared to non-frail patients. When predicting in-hospital mortality the OFS (AUC 0.70), 11-factor modified Frailty Index (AUC 0.71), and Revised Cardiac Risk Index (AUC 0.70) all showed modest discriminatory ability. Conclusion Frail patients with periprosthetic femur fractures suffer from a disproportionately increased risk of in-hospital mortality, complications, and ICU admission. Additional investigations are warranted to determine what measures are required to mitigate adverse events in this vulnerable patient population. Clinical trial number Not applicable