Predictors of postoperative complications in frail patients undergoing hip fracture surgery

Abstract

Postoperative complications significantly impact recovery and overall health in frail and older patients undergoing hip fracture surgery. This study aims to determine the predictors associated with severe complications, as classified by the Clavien-Dindo system (grade ≥ 3). A retrospective cohort study was conducted on patients aged ≥ 65 years who underwent hip fracture surgery from January 2019 to December 2024. We assessed complication severity using the Clavien-Dindo classification, categorizing cases as minor (grade < III) or severe (grade ≥ III). Logistic regression analyses were performed to identify factors independently associated with severe complications, and a corresponding risk estimation model was developed. Among 417 analyzed patients, 22 (5.3%) developed Clavien-Dindo ≥ III complications. Multivariable logistic regression revealed that male sex, Preoperative ECG abnormality, Myocardial infarction within the previous 6 months, preoperative dementia, surgery delayed more than 24 h, and postoperative acute kidney injury (AKI) were independently associated with severe complications ( P  < 0.05). Based on these variables, the resulting calculator demonstrated good discriminative performance, with an area under the ROC curve (AUC) of 0.825. Several perioperative factors were associated with severe postoperative complications following hip fracture surgery. The derived model demonstrated good discrimination in this single-center cohort; however, external validation is required before its broader clinical application. Not applicable.