Research Paper Volume 13, Issue 5 pp 7190—7198

Frailty is an independent risk factor of one-year mortality after elective orthopedic surgery: a prospective cohort study

Xiaoyun Sun1, *, , Yuying Shen2, *, , Muhuo Ji3, , Shanwu Feng1, , Yuzhu Gao4, , Jianjun Yang5, , Jinchun Shen4, ,

  • 1 Department of Anesthesiology, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
  • 2 Department of General Practice, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
  • 3 Department of Anesthesiology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing 210003, China
  • 4 Department of Anesthesiology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
  • 5 Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
* Equal contribution

Received: October 10, 2020       Accepted: January 4, 2021       Published: February 26, 2021
How to Cite

Copyright: © 2021 Sun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Frailty is associated with perioperative adverse outcomes, especially for the elderly. This study aimed to assess whether frailty was an independent risk factor of one-year mortality in frail patients after elective orthopedic surgery. In this prospective study, three hundred and thirteen patients aged ≥ 65 years, undergoing elective orthopedic surgery were finally included. Frailty assessed by the Clinical Frailty Score (CFS) before the surgery was present in 29.7% (93/313). Among them, 7.7% of patients (24/313) died at one year after surgery. In multivariate logistic analysis, higher CFS (OR = 2.271, 95% CI= 1.472–3.504) was found to be an independent risk factor of one-year mortality after surgery in elderly orthopedic patients. The area under the receiver operating characteristic curve of the model was 0.897 (95% CI 0.834–0.959). In addition, we found higher Charlson comorbidity index (OR= 1.498, 95% CI = 1.082–2.073) was also a significant risk factor. In conclusion, frailty is associated with increased one-year mortality in elderly patients after elective orthopedic surgery, which should be considered as a routine assessment tool in preoperative practice.


BMI: body mass index; ASA Grade: American Society of Anesthesiologists Grade; ACS: the American College of Surgeons; AGS: the American Geriatrics Society; MMSE: mini-mental state examination; BADL: basic activities of daily living; IADL: instrumental activities of daily living; CSHA: the Canadian Study of Health and Aging; CFS: the Clinical Frailty Score; Alb: albumin; Hb: hemoglobin; PLT: platelet; CRP: C-reactive protein; IL-6: interleukin-6; CCI: comprehensive complication index.