Higher Modified Frailty Index Score is Associated with Increased 30-Day Postoperative Complications Following Surgical Treatment of Tibial Shaft Fractures

Objectives: This study was conducted to determine if factors comprising the mFI were correlated with adverse outcomes following surgical intervention of tibial shaft fractures.

Methods: We identified patients 50 years or older with tibial shaft fractures that were managed surgically from a national database from 2007-2019. The 5-item mFI score, which comprised of diabetes, hypertension, congestive heart failure, dependent functional status, and chronic obstructive pulmonary disease, was calculated for each patient. Regression analysis was used to evaluate the association of different mFI scores with thirty-day postoperative outcomes.

Results: 1,159 total patients (mean age of 65 years) were included in this study. After controlling for confounding variables on multivariate analysis, compared to patients with a mFI of 0, those with a score of 1 had an increased risk of major complications (OR 5.11; p=0.038), minor complications (OR 3.11; p=0.004), readmission (OR 2.75; p=0.020), postoperative transfusion (OR 2.22; p=0.037), prolonged hospital stay (OR 1.88; p<0.001), and non-home discharge (OR 1.52; p=0.014). Similar increased risk of complications was seen for patients with a mFI of 2 compared to those with a score of 0: major complications (OR 9.49; p=0.004), readmission (OR 3.73; p=0.003), postoperative transfusion (OR 4.07; p<0.001), prolonged hospital stay (OR 2.50; p<0.001), and non-home discharge (OR 2.32; p<0.001).

Conclusion: Higher scores on the mFI were associated with higher complication rates in patients following surgical treatment of tibial shaft fractures. The modified frailty index is a useful tool for surgeons to assess risk before operation.