Validation and Reliability of the Clinical Frailty Scale for Predicting Postoperative Outcomes in Hip Fracture Surgery at Sakon Nakhon Hospital: A Prospective Validation Study
Keywords:
Clinical Frailty Scale, Frailty, Hip Fracture, Postoperative complicationsAbstract
This prospective study aimed to validate the predictive validity and inter-rater reliability of the Clinical Frailty Scale (CFS) for predicting postoperative complications and 30-day mortality in 104 patients aged 60 years and older undergoing hip fracture surgery at Sakon Nakhon Hospital. Patients were assessed preoperatively using the CFS by both physicians and nurses. Data were analyzed using ROC curve analysis, binary logistic regression, Spearman's correlation, and Intraclass Correlation Coefficient (ICC).
Postoperative complications occurred in 66.35% of patients. The overall AuROC of the CFS was 0.77 (95% CI: 0.67–0.86) for predicting postoperative complications and 0.76 (95% CI: 0.53–0.98) for 30-day mortality. A CFS cut-off score of ≥ 5 provided the optimal balance between sensitivity and specificity. Frail patients had 5.74-fold higher odds of developing postoperative complications compared with non-frail patients (OR = 5.74, p < 0.001). Inter-rater reliability between physicians and nurses was excellent (ICC = 0.94). The CFS is a suitable tool for preoperative frailty assessment in older patients with hip fractures in the general hospital setting of Thailand
References
Sing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Bliuc D, et al. Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality. J Bone Miner Res 2023;38(8):1064-75.
Charatcharoenwitthaya N, Nimitphong H, Wattanachanya L, Songpatanasilp T, Ongphiphadhanakul B, Deerochanawong C, et al. Epidemiology of hip fractures in Thailand. Osteoporos Int 2024;35(9):1661-8.
Tsang C, Boulton C, Burgon V, Johansen A, Wakeman R, Cromwell DA. Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model. Bone Joint Res 2017;6(9):550-6.
Emmerson BR, Varacallo MA, Inman D. Hip fracture overview. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2023.
Kwak MJ, Digbeu BD, des Bordes J, Rianon N. The association of frailty with clinical and economic outcomes among hospitalized older adults with hip fracture surgery. Osteoporos Int 2022;33(7):1477-84.
Allison R 2nd, Assadzandi S, Adelman M. Frailty: Evaluation and management. Am Fam Physician 2021;103(4):219-26.
Ikram A, Norrish AR, Marson BA, Craxford S, Gladman JRF, Ollivere BJ. Can the Clinical Frailty Scale on admission predict 30-day survival, postoperative complications, and institutionalization in patients with fragility hip fracture? A cohort study of 1,255 patients. Bone Joint J 2022;104-B(8):980-6.
Roopsawang I, Thompson H, Zaslavsky O, Belza B. Predicting hospital outcomes with the reported Edmonton frail scale-Thai version in orthopaedic older patients. J Clin Nurs 2020 ;29(23-24):4708-19.
Dong X, Zhang X, Hu F, Yang S, Hong Z, Geng Q. Association of frailty with adverse outcomes in surgically treated geriatric patients with hip fracture: A meta-analysis and trial sequential analysis. PLoS One 2024;19(6):e0305706.
Kistler EA, Nicholas JA, Kates SL, Friedman SM. Frailty and short-term outcomes in patients with hip fracture. Geriatr Orthop Surg Rehabil 2015;6(3):209-14.
Yan B, Sun W, Wang W, Wu J, Wang G, Dou Q. Prognostic significance of frailty in older patients with hip fracture: A systematic review and meta-analysis. Int Orthop 2022;46(12):2939-52.
Jesadaporn P, Teepaneeteerakul S, Wongsarikan N, Phirom K, Poonthananiwatkul S, Limpawattana P. Translation and validation of the Thai clinical frailty scale and classification tree in older adults. BMC Geriatr 2025;25(1):339.
Narula S, Lawless A, D'Alessandro P, Jones CW, Yates P, Seymour H. Clinical Frailty Scale is a good predictor of mortality after proximal femur fracture: A cohort study of 30-day and one-year mortality. Bone Jt Open 2020;1(8):443-9.
Jones HG, Hathaway I, Glossop S, Bhachoo H, Hoade L, Froud J, et al. The clinical frailty scale as a predictor of orthopaedic outcomes: A narrative review. Injury 2024;55(6):111450.
Kay RS, Hughes M, Williamson TR, Hall AJ, Duckworth AD, Clement ND. The Clinical Frailty Scale can be used retrospectively to assess the frailty of patients with hip fracture: A validation study. Eur Geriatr Med 2022;13(5):1101-7.
Guan Y, Zheng L, Wang Y, Xu X, Zhu Y . Risk factors for death or serious adverse events within 3 months after surgery in frail older persons with hip fractures and development and validation of a risk prediction model based on LASSO logistic regression. BMC Geriatr 2025;25:463.
Zaib J, Madni A, Saad Azhar M. Predictive value of comprehensive geriatric assessment scores for mortality in patients with hip fracture: A retrospective cohort study. Cureus 2023 ;15(9):e45070.
Goh EL, Khatri A, Costa AB, Ting A, Steiner K, Png ME, et al. Prevalence of complications in older adults after hip fracture surgery: A systematic review and meta-analysis. Bone Joint J 2025;107-B(2):139-48.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143(1):29-36.
Feng C, Wu H, Qi Z, Wei Y, Yang B, Yin H, et al. Association of preoperative frailty with the risk of postoperative delirium in older patients undergoing hip fracture surgery: a prospective cohort study. Aging Clin Exp Res 2024;36(1):16.
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016;15(2):155-63.
Hörlin T, Ekelund U, Mellhammar L, Linge HM. Inter-rater reliability of the Clinical Frailty Scale by staff members in a Swedish emergency department setting. Acad Emerg Med 2023;30(4):357-64.
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