J Korean Med Sci.  2025 Mar;40(12):e40. 10.3346/jkms.2025.40.e40.

Prediction of 5-Year Survival Rate After Hip Fracture Surgery Using a Comprehensive Geriatric Assessment-Based Frailty Score Model

• Choi JY
• Park JW
• Kim Ki
• Lee YK
• Kim CH

• KMID: 2566255
• DOI: http://doi.org/10.3346/jkms.2025.40.e40

Abstract

Background
Hip fractures (HFs) are major osteoporotic injuries associated with morbidity, loss of independence, increased mortality, and an increased socioeconomic burden. The total number of HFs is increasing owing to an aging population. While studies have focused on 30-day or 1-year mortality after HF surgery, studies reporting long-term mortality are lacking. Our study bridges this knowledge gap by exploring the relationship between frailty, postoperative complications, and the 5-year mortality after HF surgery. This study aimed to identify the risk factors associated with 5-year mortality after HF surgery. The impact of the Hip-Multidimensional Frailty Score (Hip-MFS) and postoperative complications on 5-year mortality was compared.
Methods
This retrospective study included 536 individuals aged 65 years and older with HFs who underwent surgery between 2009 and 2014. The Hip-MFS was calculated using the comprehensive geriatric assessment. Patients whose Hip-MFS score above 8 considered as frail. Postoperative complications included pneumonia, urinary tract infection, delirium, pulmonary thromboembolism, and unplanned intensive care unit admission after surgery. The primary outcome was 5-year mortality. Univariate and multivariate cox-regression, Kaplan–Meier analysis and log-rank tests were used to assess predictive value of frailty and postoperative complications on 5-year mortality.
Results
The mean age was 80.5 ± 7.0 years and 71.3% (n = 382) were women. Overall, 48.3% (n = 259) were diagnosed with femoral neck fractures, and 51.7% (n = 277) were diagnosed with intertrochanteric fractures. A total of 223 (41.6%) patients experienced postoperative complications. The overall mortality rate was 60.4% (n = 324), with 1-year and 5-year mortality rates after HF surgery being 13.8% (n = 74) and 43.8% (n = 235), respectively. In the multivariate regression analysis, after adjusting for clinical and demographic factors, the high-risk Hip-MFS group and the group with postoperative complications had hazard ratios for 5-year survival of 1.513 (95% confidence interval [CI], 1.105–2.017; P = 0.010) and 1.470 (95% CI, 1.117–1.936; P = 0.006), respectively. Patients who had postoperative complications with a low Hip-MFS showed better 5-year survival than those without postoperative complications with a high Hip-MFS in the Kaplan–Meier curve (P = 0.013).
Conclusion
A high Hip-MFS risk and postoperative complications were associated with an increased 5-year mortality rate. In comparison to the occurrence of postoperative complications, the frailty status evaluated using the Hip-MFS had a more significant impact on long-term mortality after HF surgery.

Keyword

Frailty; Postoperative Complications; Mortality; Hip Fracture Surgery; Older Patients

Figure

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  Fig. 1 Incidence of 5-year mortality. Incidence of 5-year mortality according to (A) the Hip-MFS and (B) postoperative complications.Hip-MFS = Hip-Multidimensional Frailty Score.

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  Fig. 2 Comparison of the area under the ROC curve for 5-year all-cause mortality. Comparison between Hip-MFS and (A) chronological age and (B) ASA classification.ROC = receiver operating characteristic, Hip-MFS = Hip-Multidimensional Frailty Score, ASA = American Society of Anesthesiologists classification, AUC = area under curve.

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  Fig. 3 Kaplan–Meier curve for 5-year mortality according to the Hip-MFS risk and postoperative complications.Hip-MFS = Hip-Multidimensional Frailty Score.

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