Frailty Before Fixation: Clinical Frailty as a Predictor of Early Mobility Recovery and Postoperative Morbidity After Proximal Femur Fracture Surgery in Older Adults
Background: Frailty reflects diminished physiological reserve and may influence postoperative recovery after proximal femur fracture surgery in older adults. This study evaluated clinical frailty as a predictor of early functional recovery and postoperative complications. Methods: This prospective observational study included 69 patients aged ≥60 years undergoing surgery for proximal femur fractures in the Department of Emergency Medicine, Kanachur Institute of Medical Sciences, Mangalore, from January to December 2025. Frailty was assessed using the Clinical Frailty Scale (CFS), with CFS ≥5 defining frailty. Early ambulation, Parker Mobility Score, hospital stay, and postoperative complications were evaluated. Results: Twenty-nine patients (42.0%) were frail. Frail patients required significantly longer to achieve first ambulation than non-frail patients (4.4±1.8 vs 2.5±1.1 days; p<0.001). Ambulation by postoperative day three was achieved in 34.5% of frail versus 77.5% of non-frail patients. Postoperative complications occurred in 51.7% and 20.0%, respectively (p=0.006). Frailty independently predicted delayed functional recovery (adjusted OR 4.82; 95% CI 1.66–14.02) and postoperative complications (adjusted OR 3.26; 95% CI 1.09–9.73). Conclusion: Preoperative clinical frailty independently predicted slower functional recovery and greater postoperative morbidity following proximal femur fracture surgery.