Modified Frailty Index Combined with a Prognostic Nutritional Index for Predicting Postoperative Complications of Hip Fracture Surgery in Elderly

Abstract

Aim: There is currently no consensus on the best risk assessment technique for predicting complications after hip surgery in the elderly, which is hindering the accuracy of surgical risk assessment. The goal of this study was to build a risk assessment model and evaluate its predictive value using the modified frailty index (5-mFI) and the prognostic nutritional index (PNI).

Methods: A retrospective investigation was undertaken on 150 patients (aged ≥60 years) who had hip fracture surgery. Using univariate and multivariate logistic regression models, the relationship between combined 5-mFI and PNI and the evaluation of postoperative unfavorable outcomes such as infection and unscheduled intensive care unit (ICU) admission was investigated. Finally, utilizing receiver operating characteristic (ROC) curve analysis, the model’s predictive value for adverse outcomes following hip fracture surgery in elderly patients was assessed.

Results: Univariate and multivariate logistic analyses revealed that preoperative PNI, 5-mFI, ASA, and gender acted as independent predictors of adverse outcomes after hip fracture surgery in the elderly. According to the ROC curve analysis, the predictive model demonstrated a high predictive value for total postoperative complications (AUC: 0.788; 95%CI: 0.715–0.860; p<0.01), infectious complications (AUC: 0.798; 95% CI: 0.727–0.868; P<0.001), and unplanned ICU admission (AUC: 0.783; 95% CI: 0.705–0.861; P<0.001).

Conclusions: The multivariable evaluation model, which included 5-mFI and PNI, showed a high predictive value and can hence be applied to predict the adverse outcomes in elderly patients undergoing hip fracture surgery.

Keywords:

• Hip fracture
• postoperative complications
• risk prediction
• improved frailty index
• prognostic nutritional index

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was approved by the ethics committee (ky20210107), the data came from the Affiliated Hospital of Medical College of Ningbo University, and this work is supported by Ningbo Science and Technology Innovation 2025 Major Special Project (2019B10035), Core Curriculum Construction Project of Ningbo University School of Medicine. High-level talent research start-up fund of the affiliated hospital of medical school of Ningbo University (2021KYQDJ-XZP).