Abstract
BACKGROUND: Proximal femur fractures are common in elderly patients and are strongly associated with frailty, increased mortality, and functional decline. The Clinical Frailty Scale (CFS) has emerged as a key predictor of outcomes, influencing perioperative management and rehabilitation strategies. This study aims to evaluate the impact of frailty on mortality, surgical timing, and length of hospital stay (LOS) in patients with hip fractures. METHODS: This single-center retrospective study analyzed data from patients aged ≥ 65 years admitted with AO type 31A and 31B proximal femur fractures between 2018 and 2023. Patients were stratified according to CFS scores to assess the relationship between frailty and in-hospital mortality, surgical delay, and LOS. Multivariate logistic regression was performed to identify independent risk factors. RESULTS: Among 2312 patients (median age: 85 years), frailty was a significant predictor of mortality (p = 0.019). Patients with CFS 7-9 had a 6.6-fold higher mortality risk than those with CFS 1-3. Delays in surgery beyond 48 h were associated with a doubled risk of mortality (p = 0.009), particularly in frail patients. Prolonged LOS (> 7.1 days) correlated with an increased incidence of infections, cardiovascular events, and mortality (p < 0.001). CONCLUSIONS: Frailty significantly impacts hip fracture prognosis in elderly patients, increasing mortality, complications, and LOS. Early identification of frail patients and prioritization of timely surgery are crucial to improving outcomes. Future studies should explore tailored surgical strategies and optimized rehabilitation protocols to enhance recovery in this high-risk population.