K. Todd1, J. L’Huillier1, H. Logghe1, K. Jalal1, W. Flynn1, J. Jordan1, W. A. Guo1 1State University Of New York At Buffalo, Jacobs School Of Medicine, Buffalo, NY, USA
Introduction:
Rib fractures are a major cause of morbidity and mortality in the geriatric trauma population. Age and frailty are both associated with poor outcomes in geriatric patients with rib fractures, however the degree of association of each factor is unknown. We sought to investigate differences in outcomes by degree of frailty and whether age or frailty is more predictive of mortality.
Methods:
The 2013–2018 TQIP database was queried for all geriatric patients (age ≥ 65) who sustained at least one rib fracture. Patients with a non-thoracic AIS score of ≥ 2 were excluded from the analysis. Patients were then stratified into three frailty groups based on the modified frailty index. Outcomes including mortality, hospital length of stay (LOS), ventilator days, ICU LOS, and rate of discharge to home were compared following propensity score matching. A Cox proportional-hazard model was generated to examine the impact of age and frailty on mortality.
Results:
102,307 geriatric patients were included in the study with 23,825 non-frail, 39,017 moderately frail, and 39,465 severely frail patients. Pairwise comparisons of the matched data showed higher mortality, longer ICU stay, increased number of ventilator days, and a decreased likelihood of discharge to home (p < 0.001) in the severely frail group. There was also a significantly longer length of stay when comparing the non-frail group to the moderately frail (p < 0.0001) and severely frail groups (p < 0.0001), however there was no significant difference in length of stay between the moderately frail and severely frail groups (p = 0.0889). While the raw Cox model showed an association between both age (p < 0.0001) and frailty (p < 0.0301) and decreased survival, the matched Cox proportional hazard regression analysis revealed that only age was associated with significantly worse survival (p<0.0001), as shown in the table. There was no association between frailty and survival (p=0.2215) in the matched Cox model.
Conclusion:
While severe frailty is associated with poorer outcomes in geriatric patients who suffered rib fractures including increased length of ICU stay, longer ventilator time, and more frequent discharge to rehab, chronological age is associated with worse survivorship. While age remains a critical factor to consider when prognosticating the risk of mortality, overall outcomes in geriatric traumatic rib fractures will require attention to both chronological and physiological ages.
