Frailty and Nottingham Hip Fracture Score for Predicting 90-Day Mortality After Hip Fracture Surgery

Hip fractures in older adults are associated with substantial morbidity, loss of independence, and high early mortality. Identifying patients at increased risk of poor outcomes is therefore an important part of perioperative care and treatment planning. Several clinical tools have been developed to estimate short-term mortality following hip fracture surgery. Among these, the Nottingham Hip Fracture Score (NHFS) is widely used and has been validated in multiple patient cohorts.

The NHFS is calculated using routinely available clinical variables such as age, comorbid conditions, and laboratory values. Although this score performs reasonably well in predicting short-term mortality, it mainly reflects comorbidity burden and demographic factors. It does not directly measure the patient's physiological reserve or overall vulnerability to stress.

Frailty has gained increasing attention as an important determinant of surgical outcomes in older adults. Frailty represents a state of reduced physiological reserve that limits the ability to recover from acute health events such as trauma or surgery. The Clinical Frailty Scale (CFS) is a practical bedside tool that classifies frailty based on functional status and the level of independence prior to illness or injury. Because it can be applied quickly in routine clinical settings, it has been used in various studies evaluating outcomes in geriatric populations.

Despite growing interest in frailty assessment, its added value when combined with established hip fracture risk scores remains uncertain. In particular, there is limited prospective evidence examining whether frailty assessment improves mortality prediction beyond existing tools such as the NHFS.

This prospective observational cohort study will collect standardized clinical data from older adults undergoing surgical treatment for proximal femoral fractures. Frailty will be assessed at hospital admission using the Clinical Frailty Scale based on the participant's functional status before the fracture. The Nottingham Hip Fracture Score will be calculated from routinely recorded clinical variables.

The analysis will examine the relationship between NHFS, frailty status, and short-term mortality following surgery. Predictive models including NHFS alone will be compared with models that incorporate both NHFS and frailty status in order to determine whether frailty provides additional prognostic information.

Understanding whether frailty assessment improves risk prediction may help clinicians identify vulnerable patients earlier and support more individualized perioperative management in older adults with hip fractures.

Inclusion criteria

• Age 60 years or older
• Admission for acute proximal femoral fracture (femoral neck, intertrochanteric, or subtrochanteric fracture)
• Surgical treatment for hip fracture
• Ability to obtain clinical data required for NHFS and frailty assessment

Exclusion criteria

• Pathological fractures
• Periprosthetic fractures
• Hip fractures resulting from high-energy trauma or polytrauma
• Non-operative treatment
• Second hip fracture occurring in the same patient during the study period