The modified 5-item frailty index determines the length of hospital stay and accompanies with mortality rate in patients with bone and implant-associated infections after trauma and orthopedic surgery

Background: Bone and implant-associated infections are severe complications after trauma and ortho-pedic surgery. The modified 5-item frailty index (mFI-5) is an easily applicable score to predict adverse outcome after surgery. The current literature regarding mFI-5 is focused on a period of 30-days postop-erative.Purpose: This study aims to assess the impact of frailty in orthopedic trauma patients with bone and implant-associated infections. mFI-5 was calculated from a database, which prospectively collects data about factors potentially correlated with peri-and postoperative complications since 2014.Methods: In a level I trauma center a total of 345 patients with surgical site infections were enrolled in this study. Hereof, patients with fracture-related infections after osteosynthesis, periprosthetic joint in-fections of the hip and knee and post-operative osteomyelitis were included. Extensive medical baseline examination was performed in 2013/14, a three-year follow-up was organized as a telephone interview. The mFI-5 score was calculated based on the 5 factor-principle as established by Subramaniam. The nu-tritional status was assessed using the Nutritional Risk Screening (NRS-2002).Results: 130 patients were included, whereof seven had died, resulting in 123 patients. A grouping of our patients was performed in mFI-5 = 0 ( n = 46; 36,4%), mFI-5 = 1 ( n = 41; 33,3%) or mFI-5 >= 2 ( n = 36; 29,3%). Sex distribution showed 69,1% male and 30,9% female patients. Frailty did neither impact on the re-admission ( p = 0,433) nor the reoperation ( p = 0,327) rate in our cohort. The mortality risk nearly doubled (1,7 times) in frail patients, but did not reach significance. In hospital stay was prolonged due to frailty (12,1 +/- 11,8; p = 0,004) compared to those with a mFI-5 = 0 (5,9 +/- 5,1) or mFI-5 = 1 (6,9 +/- 5,9). Frailty goes along with a risk of malnutrition and increases with age.Conclusion: The modified 5-item frailty index is not a suitable screening tool for predicting revision rate, re-admission rate, and mortality in our orthopedic trauma patient population with bone and implant -associated infections. Nevertheless, frailty is associated with an increased risk of malnutrition and in-creases with age.(c) 2023 Elsevier Ltd. All rights reserved.