Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures

Shahin Mohseni; Maximilian Peter Forssten; Ahmad Mohammad Ismail; Yang Cao; Frank Hildebrand; Babak Sarani; Marcelo Af Ribeiro Jr

doi:10.1136/tsaco-2023-001206

Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures

Trauma Surg Acute Care Open. 2024 Feb 7;9(1):e001206. doi: 10.1136/tsaco-2023-001206. eCollection 2024.

Authors

Shahin Mohseni^{1

2}, Maximilian Peter Forssten^{3

4}, Ahmad Mohammad Ismail^{3

4}, Yang Cao⁵, Frank Hildebrand⁶, Babak Sarani⁷, Marcelo Af Ribeiro Jr²

Affiliations

¹ Orebro universitet Fakulteten for medicin och halsa, Orebro, Sweden.
² Department of Surgery, Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, UAE.
³ Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.
⁴ School of Medical Sciences, Orebro University, Orebro, Sweden.
⁵ Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden.
⁶ Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany.
⁷ George Washington University, Washington, District of Columbia, USA.

Abstract

Background: Studies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined. In the current investigation, we sought to delineate the association between frailty, measured using the Orthopedic Frailty Score (OFS), and outcomes in geriatric patients with isolated rib fractures.

Methods: All geriatric (aged 65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement database with a conservatively managed isolated rib fracture were considered for inclusion. An isolated rib fracture was defined as the presence of ≥1 rib fracture, a thorax Abbreviated Injury Scale (AIS) between 1 and 5, an AIS ≤1 in all other regions, as well as the absence of pneumothorax, hemothorax, or pulmonary contusion. Based on patients' OFS, patients were classified as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The prevalence ratio (PR) of composite complications, in-hospital mortality, failure-to-rescue (FTR), and intensive care unit (ICU) admission between the OFS groups was determined using Poisson regression models to adjust for potential confounding.

Results: A total of 65 375 patients met the study's inclusion criteria of whom 60% were non-frail, 29% were pre-frail, and 11% were frail. There was a stepwise increased risk of complications, in-hospital mortality, and FTR from non-frail to pre-frail and frail. Compared with non-frail patients, frail patients exhibited a 87% increased risk of in-hospital mortality [adjusted PR (95% CI): 1.87 (1.52-2.31), p<0.001], a 44% increased risk of complications [adjusted PR (95% CI): 1.44 (1.23-1.67), p<0.001], a doubling in the risk of FTR [adjusted PR (95% CI): 2.08 (1.45-2.98), p<0.001], and a 17% increased risk of ICU admission [adjusted PR (95% CI): 1.17 (1.11-1.23), p<0.001].

Conclusion: There is a strong association between frailty, measured using the OFS, and adverse outcomes in geriatric patients managed conservatively for rib fractures.

Keywords: frailty; geriatrics; rib fractures.