The Modified Five-Factor Frailty Index Predicts Non-routine Hospital Discharge in Elderly Inpatients Following Surgical Fixation of Olecranon Fractures
TL;DR
Frailty, age, and female sex are significant predictors of non-routine discharge in elderly inpatients undergoing surgical fixation for displaced olecranon fractures, highlighting the importance of incorporating frailty assessments into both preoperative surgical decision-making and postoperative discharge planning to improve care transitions and outcomes.
Abstract
With an aging United States population, the incidence of perioperative complications following orthopedic procedures, including surgical management of olecranon fractures, is increasing. These complications affect not only patient outcomes but also discharge disposition. Identifying risk factors for non-routine hospital discharge, including frailty, is critical for optimizing postoperative care and discharge planning in the elderly. We hypothesized that increasing frailty as measured by the modified five-factor frailty index (mFI-5) would be independently associated with non-routine discharge following surgical fixation of olecranon fractures. The National Inpatient Sample (NIS) was analyzed (2015-2019), focusing on elderly patients (aged ≥ 65 years) with displaced olecranon fractures who underwent surgical fixation. Patients were categorized by frailty status using the modified five-factor frailty index (mFI-5). Adverse hospitalization events and discharge status were compared. A total of 5185 patients undergoing surgical intervention for displaced olecranon fractures were included in the study. As rated by the mFI-5, 1125 (21.7%) were non-frail, 2565 (49.5%) were prefrail, 1175 (22.7%) were frail, and 320 (6.2%) were severely frail. Age greater than 80 years was an independent risk factor for non-routine discharge [OR: 2.989 (2.640-3.386), P < 0.001]. Prefrail, frail, and severely frail patients had a significantly increased likelihood of non-routine discharge [OR: 1.422, P < 0.001; OR: 1.857, P < 0.001; and OR: 1.478, P = 0.010, respectively]. Female sex was also an independent predictor [OR: 1.340 (1.158-1.551), P < 0.001]. Frailty, age, and female sex are significant predictors of non-routine discharge in elderly inpatients undergoing surgical fixation for displaced olecranon fractures. These findings highlight the importance of incorporating frailty assessments into both preoperative surgical decision-making and postoperative discharge planning to improve care transitions and outcomes.