Frailty Is a Predictor of Inpatient Mortality and Unplanned ICU Admission Following Early Fixation of Intertrochanteric Fractures.

Abstract

This study sought to examine the role of frailty in predicting inpatient mortality following early surgical fixation of intertrochanteric (IT) fractures. The ACS-TQIP (2017-21) database was queried for patients with intertrochanteric fractures undergoing surgical fixation within 48 h. Frailty status was determined using the 5-item modified frailty index (mFI-5) (0 = nonfrail, 1 = prefrail, and, 2 = frail, and > 2 = severely frail). The primary end point was inpatient mortality. Secondary end points were unplanned ICU admission and thromboembolic events (DVT or PE). Significance was considered a <i>p</i>-value < 0.05. Frailty, as determined by the mFI-5, was a significant predictor of inpatient mortality and unplanned ICU admissions. Frail and severely frail patients had higher odds of mortality (OR: 2.00 and 3.58, respectively) and ICU admission (OR: 1.66, 3.09, 3.83, respectively). When compared with nonoperative management in frail (OR: 0.561) and severely frail (OR: 0.665) patients, surgical intervention within 48 h significantly reduced the risk of mortality. Increasing frailty status, as measured by the mFI-5, has increased odds for unplanned ICU admission and inpatient mortality following surgery within 48 h for IT fractures. Although operative management is required in these patients, these results suggest frailty may be used to preoperatively identify patients at high risk for adverse events. Future studies may seek to identify modifiable factors in the preoperative period to improve outcomes in frail patients. The online version contains supplementary material available at 10.1007/s43465-026-01751-z.