Frailty and Time-To-Theatre for Elderly Hip Fracture Patients at a Regional Hospital in Australia: A Retrospective Cohort Study.

Abstract

Elderly hip fracture patients constitute a vulnerable population in whom operative management is frequently required. Comorbidities commonly exist and are often a factor leading to delays in entry to the operating room. Our regional hospital manages many hip fractures and we sought to understand the demographic and medical details of this group, and whether frailty was a factor in time-to-theatre and length of stay (LOS). We conducted a retrospective cohort study of all patients over 65 years with hip fractures managed operatively at our regional hospital in Australia from 2018-2022. Demographics, and details of medical, surgical and anaesthetic management were collected. Data to allow calculation of a frailty score (the 11-item modified frailty index (mFI-11)) were collected to allow determination of a 'frail' and 'non-frail' cohort. These cohorts were compared with respect to time-to-theatre and LOS. Our cohort consisted of 453 subjects. Median age was 83.1 years (range 65-103). Most subjects (71.5%) were living in the community pre-fracture. 324 subjects were 'frail'. Average time-to-theatre was longer in the frail cohort (28.9 h (frail) vs 22.0 h (non-frail), <i>P</i><0.0001), as was average LOS (7.4 days (frail) vs 6.3 days (non-frail), <i>P</i>=0.0077). However, after adjusting for ASA score, age and sex, there was no longer evidence of these relationships (time-to-theatre, P=0.054; LOS, <i>P</i>=0.477). Post hoc subgroup analyses revealed that frail subjects had longer LOS if time-to-theatre was >24h, and that frail subjects had higher odds of any complication than non-frail subjects, whether time-to-theatre was <24h or >24h. This study confirmed a demographic profile for elderly hip fracture patients at our hospital similar to that noted in large databases. Although the mFI-11 may retain value in defining clinically complex hip fracture patients, we were unable to find evidence of its utility as an independent predictor of time-to-theatre or LOS.