Clinical utility of the modified frailty index for predicting postoperative complications in elderly patients with intertrochanteric femoral fractures.

objectiveTo evaluate the clinical utility of the modified frailty index (mFI-5) in predicting postoperative complications among elderly patients with intertrochanteric femoral fractures.

methodsThe clinical data of 432 patients aged 65 years or older were retrospectively analyzed. Based on their mFI-5 scores, patients were categorized into frail and non-frail groups. The incidence of postoperative complications was compared between the two groups. Binary multivariate logistic regression analysis was performed to identify the predictive role of frailty. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance of mFI-5 and to determine its optimal cutoff value. A prediction formula was constructed according to the multivariate regression results.

resultsThe overall complication rate was significantly higher in the frail group than that in the non-frail group [42 cases (33.33%) vs. 10 cases (3.27%); P < 0.001]. Multivariate logistic regression analysis revealed that the risk of postoperative complications in frail patients was 11.26-fold higher than that in non-frail patients (odds ratio = 11.26, 95% confidence interval [CI]: 5.38-22.49; P = 0.003). Frailty was identified as an independent risk factor for postoperative lower-extremity deep vein thrombosis, delirium, and pneumonia. ROC curve analysis demonstrated that mFI-5 had good discriminative ability for predicting total postoperative complications (area under the curve = 0.86, 95% CI: 0.81-0.91). The optimal mFI-5 cutoff value was 2 points, corresponding to a sensitivity of 82.1% and a specificity of 79.3%. The prediction formula established was: Logit (P) = -3.24 + 1.86 × mFI-5 + 0.52 × American Society of Anesthesiologists classification (III-IV = 1, I-II = 0) - 0.03 × preoperative hemoglobin (g/L), which can be used to estimate the probability of postoperative complications.

conclusionThe mFI-5 score serves as an effective tool for predicting postoperative complications in elderly patients with intertrochanteric femoral fractures. The derived model formula and ROC curve analysis further support its clinical applicability. Preoperative mFI-5 assessment can provide a useful reference for comprehensive perioperative c management and help improve patient outcomes.