Comparing Frailty and Traditional Risk Models in Predicting 6-Month Mortality After Hip Fracture in Older Adults: A Retrospective Study from a Single Center

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Background: Mortality risk in patients with hip fractures is influenced by multiple factors, including age, pre-existing medical conditions, and frailty. This study aims to compare the predictive ability of 6-month mortality between traditional risk models—the American Society of Anesthesiologists (ASA) classification, the Hip Fracture Estimator of Mortality of Amsterdam (HEMA), and the Nottingham Hip Fracture Score (NHFS)—and frailty assessment. Methods: This retrospective study included patients who were admitted to the Orthopedics and Traumatology Clinic with intracapsular femoral neck fractures treated with hemiarthroplasty and with extracapsular intertrochanteric fractures treated with intramedullary nailing between 1 January 2023 and 31 December 2023. Demographic and clinical data were retrieved from medical records, and survival status at 6 months post-admission was determined using the Turkish Death Registry System. The frailty status was determined retrospectively from electronic medical records using the Clinical Frailty Scale (CFS) by a trained specialist. Results: A total of 164 patients were analyzed, with a mean age of 78.2 ± 8.9 years, and 64.6% (n = 106) were female. The 6-month mortality rate was 31.1% (n = 51). Frailty, as measured by CFS, was significantly associated with increased mortality risk [hazard ratio: 4.465, 95% confidence interval (CI): 2.588–7.703, p < 0.001]. Receiver Operating Characteristic (ROC) analysis demonstrated that all risk models were predictive of 6-month mortality, with CFS exhibiting the highest area under the curve (AUC) (CFS: AUC = 0.879 (95% CI: 0.824–0.934, p < 0.001). Conclusions: In this cohort, several perioperative risk scores were associated with mortality; however, frailty measured by the CFS provided stronger discrimination for medium-term prognosis after hip fracture surgery. Incorporating frailty assessment alongside perioperative risk evaluation may improve risk stratification and support orthogeriatric care planning and postoperative management in this high-risk population.

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