Correlation of preoperative fibrinogen/albumin ratio with morbidity following advanced-age hip fractures: an observational study.

Purpose

Given the occurrence of comorbidities in geriatric patients, the postoperative period of hip fractures may progress with high morbidity and mortality. Recently, several inflammatory markers have been used to evaluate the treatment course. Herein, we prospectively followed-up and examined the relationship between preoperative fibrinogen/albumin ratio(FAR) and morbidity/mortality in elderly patients with hip fracture.

Methods

Patients aged ≥ 85 years who underwent hip fracture surgery under unilateral spinal anesthesia were included in this prospective observational study. The patients' preoperative FAR, age-adjusted Charlson comorbidity index(AACCI) score, Nottingham Hip Fracture Score, and Clinical Frailty Scale score were calculated. In addition, data on patients' morbidity, 3-month mortality, and lengths of intensive care unit (ICU) and hospital stay were recorded. The patients were categorized into two groups based on the FAR cutoff value of 0.102. A total of 108 patients participated in the study, with 43 assigned to Group 1(FAR < 0.102) and 65 to Group 2(FAR ≥ 0.102).

Results

A significant difference was found in the risk of death within 3-months between patients with high and low FAR scores(p = 0.018). Patients with higher FAR scores were more likely to die within 3 months. A significantly positive association was observed between the FAR and AACCI score, with the AACCI score of Group2 being significantly higher than that of Group 1(p = 0.029). The lengths of hospital(p = 0.044) and ICU(p = 0.013) stay were significantly higher in Group2 than in Group1.

Conclusion

Preoperative FAR, which is an inexpensive and readily available test, is a promising index for predicting mortality and complications in patients with hip fracture.

COI Statement

Declarations. Conflict of interest: The authors declare no conflicts of interest.

References:

• Alterovitz SS, Mendelsohn GA. Relationship goals of middle-aged, young-old, and old-old internet daters: an analysis of online personal ads. J Aging Stud. 2013;27:159–65.
• Bhushan S, Huang X, Duan Y, Xiao Z. The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: a systematic review and meta-analysis. Int J Surg. 2022;105: 106854.
• Haleem S, Choudri MJ, Kainth GS, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last SIXTY years. Injury. 2023;54:620–9.
• Seong YJ, Shin WC, Moon NH, Suh KT. Timing of hip-fracture surgery in elderly patients: literature review and recommendations. Hip Pelvis. 2020;32:11–6.
• Di Martino G, Di Giovanni P, Cedrone F, D’Addezio M, Meo F, Scampoli P, Romano F, Staniscia T. Development and validation of a new tool in predicting in-hospital mortality for hip-fractured patients: the PRIMOF score. Medicina (Kaunas). 2022;58:1082.