Technology
Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?
This episode discusses a study examining the impact of weight-bearing status on mortality and complications in hip fracture patients, accounting for frailty. The findings suggest that immediate post-o...
Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?
Technology •
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Interactive Transcript
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Welcome back to another episode of AI Talks with Bone and Joint,
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from the publishers of Bone and Joint Open. Today, we're discussing the paper,
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does weight-bearing status impact mortality and other complications and hip fracture patients
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when accounting for frailty, published in July 2025 by M. Mao, T. Thorn, K. Rossbock,
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EH Sato, C. Zhang, AP Presson, and J.M. Holler. I'm Brian, and I'm here with my co-host, Lisa.
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Hello, everyone. Delighted to be here. This is a most intriguing topic, Brian.
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Hip fractures are a considerable health issue, particularly among the elderly. The study we're
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examining today explores how weight-bearing status influences post-operative outcomes while
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taking patient frailty into account. So, Brian, could you give us some background on hip fractures?
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Certainly, Lisa. Hip fractures are very common in older adults and come with significant risks of
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mortality and morbidity. Approximately 6% of patients die within 30 days post-fracture,
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and 22% within the year. In 2019, the incidence of fractures was 489.3 per 100,000 individuals,
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with rates much higher among the elderly. Understanding factors linked to poor outcomes is vital for
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treatment. Exactly. One of those critical factors is post-operative weight-bearing. The study focused
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on analyzing the risk of mortality and other complications following restricted weight-bearing
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and elderly patients who underwent fixation of a hip fracture, while precisely accounting for
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patient frailty. Regarding the methods, the researchers examined the National
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Surgical Quality Improvement Program and a skip database from January 2016 to December 2020,
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concentrating on patients aged 60 and above who had undergone operative fixation of hip fractures.
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They used specific CPT codes to identify a total of 53,959 patients.
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They employed logistic regressions and ROC curve analysis to determine the best frailty measure
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among the American Society of Anesthesiologist grade, five-factor modified frailty index,
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MFI5, and the recalibrated risk analysis index, RAI Rev. Additionally, the study examined the
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impact of weight-bearing status on 30-day mortality and other complications.
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And here's where it becomes interesting. The results indicated that 36,177 patients,
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or 67% were weight-bearing post-operatively. The RAI Rev was the best predictor of 30-day
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mortality. Weight-bearing patients had 42% lower odds of 30-day mortality, 31% lower odds of
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severe adverse events, and 24% lower odds of minor adverse events compared to non-weight-bearing
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patients. That's significant when controlling for frailty using the RAI Rev along with age,
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sex, BMI, functional status, and CPT codes, the study found weight-bearing was associated with
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substantial reductions in complications. However, it's noteworthy that weight-bearing didn't
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significantly affect the rates of thromboembolic events or readmissions.
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Yes, the analysis showed that restricted weight-bearing results in deconditioning,
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sarcopenia, and increased complications such as delirium, urinary tract infections,
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and pneumonia. These complications highlight the need for immediate weight-bearing post-surgery,
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as recommended by organizations like Nice and AAS.
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So, Ryan, what are the key takeaways from this study?
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First, the risk analysis index recalibrated version is the best predictor for post-operative
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mortality following a hip fracture. Second, even when considering frailty, immediate post-operative
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weight-bearing is substantially associated with lower mortality and fewer complications,
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and therefore should be encouraged for all able patients. This aligns with recommendations
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from established health organizations. To sum up, the study calls for the widespread use of the RAI
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REV, in assessing frailty in elderly patients with hip fractures and underscores the clinical
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benefits of post-operative weight-bearing. It's a crucial insight for improving patient outcomes
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backed by comprehensive data from a validated national database.
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Precisely, Lisa. This research provides substantial evidence that can shape clinical
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guidelines and patient care strategies, ultimately aiming to improve recovery rates,
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and reduce mortality in elderly hip fracture patients.
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Thank you for joining us on AI Talks with Bone and Joint. We hope you found today's
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discussion on weight-bearing status and frailty in hip fracture patients insightful.
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Stay tuned for more episodes where we delve into the latest research in orthopedic surgery.
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Until next time, this is Brian and Lisa signing off.
Topics Covered
AI Talks
hip fractures
weight-bearing status
mortality complications
elderly patients
frailty assessment
post-operative outcomes
surgical quality improvement
complications in hip fractures
RAI Rev
patient care strategies
recovery rates
orthopedic surgery research
health organizations recommendations