Impact of frailty on postoperative complications in older adults after hip fracture: a systematic review of observational studies
Bibliographic record
Abstract
Purpose: Frailty, a common syndrome involving multisystem impairment in older adults, is a significant preoperative concern for hip fracture patients. However, its specific link to postoperative complications remains unclear. This systematic review and meta-analysis investigates the association between preoperative frailty and adverse surgical outcomes in this geriatric population. Methods: We comprehensively searched several databases, including China National Knowledge Infrastructure PubMed, Embase, Web of Science, (China National Knowledge Infrastructure, CNKI), Wanfang, VIP and the Cochrane Library from January 1, 2000, to September 2024. We focused on cohort studies that examine how frailty affects prognosis after hip fracture surgery in older adults. Two researchers independently screened literature, extracted data, and assessed the quality of included studies using the Newcastle-Ottawa Scale (NOS). We used Stata 15.0 to perform the meta-analyses. Results: This review included 27 cohort studies, consisting of 19 retrospective and 8 prospective studies, involving a total of 243,264 patients. When compared to non-frail patients, frailty statistically significantly increases the risk of postoperative mortality following hip fracture. Specifically, frailty is associated within-hospital mortality [(relative risk, RR) = 3.20, 95% (confidence interval, CI): 1.93, 5.31], 30-day mortality (RR = 3.91, 95%CI: 1.89, 8.07), and 1-year mortality (RR = 1.50, 95%CI: 1.39, 1.61). Frailty also increases the rate of complications (RR = 2.81, 95%CI: 1.67, 4.74), postoperative delirium (RR = 4.44, 95%CI: 2.34, 8.41), pneumonia (RR = 4.09, 95%CI: 2.39, 7.01), and 30-day readmission (RR = 1.75, 95%CI: 1.56, 1.96). Conclusion: Frailty increases both short-term and long-term mortality following hip fracture surgery in older patients. Additionally, frailty is associated with a higher overall rate of complications, including the 30-day readmission.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.041 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.015 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".