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Relationship between clinical outcomes and Dutch frailty score among elderly patients who underwent surgery for hip fracture

Authors Winters AM, Hartog LC, Roijen HIF, Brohet RM, Kamper AM

Received 26 July 2018

Accepted for publication 15 September 2018

Published 5 December 2018 Volume 2018:13 Pages 2481—2486


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker

AM Winters,1 LC Hartog,2 HIF Roijen,1 RM Brohet,3 AM Kamper1

1Department of Geriatrics, Isala, 8025 AB, Zwolle, the Netherlands; 2Diabetes Centre, Isala, 8025 AB, Zwolle, the Netherlands; 3Isala Academy, 8025 BP, Zwolle, the Netherlands

Background: Frailty is a geriatric condition that is associated with an increased risk of mortality and functional decline. To date, mainly the Groningen Frailty Indicator (GFI) and Hospital Safety Management (VeiligheidsManagementSysteem [VMS]) frailty score are used to determine frailty in several hospitals in the Netherlands. However, it is yet unknown, which method has the best predictive value on clinical outcomes.
Objective: The aim of this study was to investigate the predictive value of GFI and VMS on clinical outcomes among patients who underwent hip fracture surgery.
Design: This is a prospective observational cohort study.
Methods: We selected all patients aged 70 years or higher, who underwent hip fracture surgery in our general hospital, between November 2014 and November 2015. Among all patients, VMS, GFI and Barthel-20 index (BI) were assessed. McNemar’s paired test and Cohen’s κ were used to examine the difference and the level of agreement between the two scoring methods. Kaplan–Meier and multivariable regression analyses were performed to determine overall survival and mortality, respectively, 3 years and 30 days after surgery.
Results: A total of 280 patients were included in the study. The median follow-up was 25 months. No systematic difference was found between the two methods (P=0.237), while a fair level of agreement could be measured (κ=0.363 [95% CI =0.23–50]). VMS showed a statistically significant difference in overall survival as compared to nonfrail patients (57 vs 80%, respectively [Plogrank <0.001] with an HR of 3.5 [95% CI =2.1–5.7; P<0.001]). Classification according to GFI yielded a lower but still significant HR 2.3 (95% CI =1.2–4.1; P=0.008).
Conclusion: VMS can be used in classifying frailty, whereby VMS frailty score is associated with clinical outcomes as overall survival mortality in older patients with hip fracture and who underwent surgery.

Keywords: orthopedic surgery, frailty assessment, geriatric patients, mortality, functional decline

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