Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of distal humerus fractures.

Introduction: We hypothesized that the modified Fragility Index (mFI), which predicts surgical complications, would be applicable to surgical complications in patients older than 50 years with distal humerus fractures (DHF).

Methods: We retrospectively reviewed the American College of Surgeons National Surgery Quality Improvement Program database, including patients older than 50 years who underwent open reduction and internal fixation of a DHF. A 5-item mFI score was calculated. Postoperative complications, readmission and reoperation rates, and length of stay were recorded. Univariate as well as a multivariable statistical analysis was performed, controlling for age, sex, body mass index, length of stay, and operative time.

Results: We identified 864 patients (mean age, 68.6 years ± 10.4), and 74.1% were female. As the mFI increased from 0 to 2 or greater, 30-day readmission rate increased from 3% to 10% ( value = .01), rate of discharge to rehabilitation facility increased from 12% to 32% ( value = .0), and any complication rate increased from 4% to 19% ( value = .0). Rates of pulmonary complications increased significantly in patients with the mFI of 2 or greater ( value = .047). Patients with the mFI of 2 or greater were nearly 4 times more likely to be readmitted within 30 days (odds ratio [OR] = 3.5, value = .007) and had an increased OR of 30-day reoperation and any complication (OR = 3.7, value = .02; OR = 4.5,  value = .00, respectively) on multivariate analysis.

Conclusion: A fragility state is predictive of postoperative complications, readmission, and reoperation after surgical management of DHF. Our data suggest that a fragility evaluation can help inform surgical decision-making in patients older than 50 years with DHF.