Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of distal humerus fractures

• Authors: Ellan B Saltzman, Duke University Medical Center; Daniel R Evans, Duke University School of Medicine; Albert Anastasio, Duke University Medical Center; Ndeye Guisse, Emory University School of Medicine; Elshaday S Belay, Duke University Medical Center; Oke A Anakwenze, Duke University Medical Center; Mark J Gage, Duke University Medical Center; Tyler S Pidgeon, Duke University Medical Center; Marc J Richard, Duke University Medical Center; David S Ruch, Duke University Medical Center; Christopher S Klifto, Duke University Medical Center
• Journal Title: JSES International
• Volume: Volume 5, Number 6
• Publisher: Elsevier | 2021-11-01, Pages 1111-1118
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.jseint.2021.07.016
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: patients; surgical management; distal humerus fractures

Abstract

Introduction: We hypothesized that the modified Fragility Index (mFI), which predicts surgical complications, would be applicable to surgical complications in patients older than 50 years with distal humerus fractures (DHF). Methods: We retrospectively reviewed the American College of Surgeons National Surgery Quality Improvement Program database, including patients older than 50 years who underwent open reduction and internal fixation of a DHF. A 5-item mFI score was calculated. Postoperative complications, readmission and reoperation rates, and length of stay were recorded. Univariate as well as a multivariable statistical analysis was performed, controlling for age, sex, body mass index, length of stay, and operative time. Results: We identified 864 patients (mean age, 68.6 years ± 10.4), and 74.1% were female. As the mFI increased from 0 to 2 or greater, 30-day readmission rate increased from 3% to 10% (P value =.01), rate of discharge to rehabilitation facility increased from 12% to 32% (P value =.0), and any complication rate increased from 4% to 19% (P value =.0). Rates of pulmonary complications increased significantly in patients with the mFI of 2 or greater (P value =.047). Patients with the mFI of 2 or greater were nearly 4 times more likely to be readmitted within 30 days (odds ratio [OR] = 3.5, P value =.007) and had an increased OR of 30-day reoperation and any complication (OR = 3.7, P value =.02; OR = 4.5, P value =.00, respectively) on multivariate analysis. Conclusion: A fragility state is predictive of postoperative complications, readmission, and reoperation after surgical management of DHF. Our data suggest that a fragility evaluation can help inform surgical decision-making in patients older than 50 years with DHF.