Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?

Listen to Brian and Lisa discuss the paper 'Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?' published in the July 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper, 'Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?' published in July 2025 by M Mau, T Thorne, K Rossbach, E H Sato, C Zhang, A P Presson, and J M Haller. I'm Brian and I'm here with my co-host Lisa. 

Hello everyone, delighted to be here. This is a most intriguing topic, Brian. Hip fractures are a considerable health issue, particularly among the elderly. The study we're examining today explores how weightbearing status influences postoperative outcomes while taking patient frailty into account. So Brian, could you give us some background on hip fractures? 

Certainly, Lisa. Hip fractures are very common in older adults and come with significant risks of mortality and morbidity. Approximately 6% of patients die within 30-days post-fracture, and 22% [00:01:00] within the year. In 2019, the incidence of fractures was 489.3 per 100,000 individuals with rates much higher among the elderly. Understanding factors linked to poor outcomes is vital for treatment. 

Exactly. One of those critical factors is postoperative weightbearing. The study focused on analyzing the risk of mortality and other complications following restricted weightbearing in elderly patients who underwent fixation of a hip fracture while precisely accounting for patient frailty.

Regarding the methods, the researchers examined the National Surgical Quality Improvement Program, NSQIP database from January 2016 to December 2020. Concentrating on patients aged 60 and above who had undergone operative fixation of hip fractures. They used specific CPT codes to identify a total of 53,959 patients.

They employed logistic regressions and ROC curve analysis to determine the best frailty [00:02:00] measure among the American Society of Anesthesiologist grade, five-factor modified Fraility Index, mFI-5, and the Recalibrated Risk Analysis Index, RAI-Rev. Additionally, the study examined the impact of weightbearing status on 30-day mortality and other complications and here's where it becomes interesting.

The results indicated that 36,177 patients, or 67% were weightbearing postoperatively. The RAI-Rev was the best predictor of 30-day mortality. Weightbearing patients had 42% lower odds of 30-day mortality, 31% lower odds of severe adverse events, and 24% lower odds of minor adverse events compared to non- weightbearing patients.

That's significant. When controlling for frailty using the RAI-Rev, along with age, sex, BMI, functional status and CPT codes. The study found weightbearing was associated with substantial reductions in [00:03:00] complications. However, it's noteworthy that weightbearing didn't significantly affect the rates of thromboembolic events or readmissions.

Yes, their analysis showed that restricted weightbearing results in deconditioning, sarcopenia, and increased complications such as delirium, urinary tract infections, and pneumonia. These complications highlight the need for immediate weightbearing post-surgery as recommended by organizations like NICE and AAOS.

So Brian, what are the key takeaways from this study? 

First, the Risk Analysis Index Recalibrated Version is the best predictor for postoperative mortality following a hip fracture. Second, even when considering frailty, immediate postoperative weightbearing is substantially associated with lower mortality and fewer complications and therefore should be encouraged for all able patients. This aligns with recommendations from established health organizations. 

To sum up, the study calls for the widespread use of the RAI-Rev, in assessing frailty in elderly patients with hip fractures and underscores the [00:04:00] clinical benefits of postoperative weightbearing. It's a crucial insight for improving patient outcomes, backed by comprehensive data from a validated national database. 

Precisely, Lisa. This research provides substantial evidence that can shape clinical guidelines and patient care strategies, ultimately aiming to improve recovery rates and reduce mortality in elderly hip fracture patients.

Thank you for joining us on AI Talks with Bone & Joint. We hope you found today's discussion on weightbearing status and frailty and hip fracture patients insightful. Stay tuned for more episodes where we delve into the latest research in orthopedic surgery. 

Until next time, this is Brian and Lisa signing off.