Age or Frailty: What Predicts Outcomes in Geriatric Patients With Rib Fractures?

Introduction: Age and frailty are associated with poor outcomes in geriatric patients with rib fractures. To date, no studies have assessed the relative and independent association of each factor using a large national dataset. We therefore sought to determine whether age, frailty, or their combined consideration most effectively predicts outcomes in geriatric patients with rib fractures. Methods: The 2017-2023 TQIP database was queried for all geriatric patients (age ≥65 y) who sustained at least one rib fracture. A multivariate analysis with propensity score matching was performed to examine the difference in outcomes between geriatric adults with low frailty or high frailty based on the modified frailty index. A logistic model controlling for sex, race, vital signs, injury scores, and comorbidities was conducted to test for association between age, frailty, and mortality. Results: In total, 203,131 geriatric patients were included. Matched geriatric patients with high frailty had higher overall mortality compared to low-frailty patients (P < 0.001). When directly compared with a multivariate analysis, age (odds ratio: 1.379, P < 0.001) and high frailty (odds ratio: 1.806, P < 0.001) were independently associated with increased risk of mortality. High frailty was associated with longer lengths of stay, higher rates of ICU admission, and more discharges to skill nursing facilities (P < 0.001). Conclusions: These results suggest that both advanced age and high frailty are both independently associated with higher mortality and worse outcomes following rib fractures in geriatric patients. Improving outcomes in geriatric rib fractures will require attention to both chronological and physiological ages.