Modified Frailty Index Identifies Increased Risk of Postoperative Complications in Geriatric Patients After Open Reduction Internal Fixation for Distal Radius and Ulna Fractures

Abstract

Background Open reduction internal fixation (ORIF) of distal radius and ulnar fractures (DRUFs) is one of the most common fracture surgeries for hand surgeons. Few studies have evaluated how frailty contributes to outcomes in geriatric hand surgery patients. This study hypothesizes that geriatric patients scoring higher on the modified Frailty Index 5 (mFI-5) are at greater risk of postoperative complications following DRUF fixation. Methods The American College of Surgeons National Surgical Quality Improvement Project database was reviewed for ORIF for DRUFs from 2005 to 2017. Statistically significant differences for demographics, comorbidities, mFI-5, and postoperative complications between geriatric and nongeriatric patients were evaluated with multivariate logistic regression analysis. Results A total of 17,097 ORIF for DRUFs were collected by the National Surgical Quality Improvement Project 2005–2017, with 5654 patients older than 64 years (33.2%). Average age for geriatric patients undergoing ORIF for DRUFs was 73.7 years. Within geriatric patients, an mFI-5 score >2 confers 1.6-times increased risk of returning to the operating room following ORIF for DRUF (adjusted odds ratio, 1.6; P = 0.02), whereas an increase in mFI-5 score >2 confers a 3.2-times increased risk of deep vein thrombosis among geriatrics (adjusted odds ratio, 3.2 P < 048). Conclusion Frailty among geriatric patients confers increased risk of deep vein thrombosis postoperatively. Geriatric patients with higher frailty scores carry a significantly increased risk of returning to the operating room within 30 days. Hand surgeons can use the mFI-5 to screen geriatric patients with DRUF patients to guide perioperative decision-making.