Association of Frailty and Preoperative Vitamin D Status with Postoperative Outcomes After Fragility Hip Fracture Surgery
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Abstract
OBJECTIVES: This study aimed to evaluate the associations of preoperative vitamin D status with postoperative outcomes in geriatric hip fracture patients managed within an integrated orthogeriatric pathway.
MATERIALS AND METHODS: This retrospective observational cohort study included 549 patients (aged ≥ 60 years) who underwent surgery for fragility hip fractures at Bangkok Hospital Headquarters between 2016 and 2025. A sub-analysis was conducted on 334 patients with available preoperative serum 25-hydroxyvitamin D (25(OH)D) levels. Key variables included age, Charlson Comorbidity Index (CCI), and prefracture frailty assessed using the Clinical Frailty Scale (CFS). The primary outcome was overall postoperative complications.
RESULTS: The mean age was 79.9 years, and 69.0% of participants were female. Frailty assessment showed that 48.8% were fit (CFS ≤ 3), 31.1% were vulnerable (CFS 4–5), and 20.0% were frail (CFS ≥ 6). Among 334 patients with available preoperative 25(OH)D measurements, vitamin D deficiency (VDD; < 20 ng/mL) was present in 46.4%. Overall postoperative complications occurred in 184 patients (55.1%), including 93/155 (60.0%) in the VDD group and 91/179 (50.8%) in the non-deficient group (p = 0.117). Lower vitamin D levels were significantly associated with higher comorbidity burden (p = 0.033) and greater frailty (p = 0.012), but not with overall postoperative complications or delirium (all p > 0.05).
CONCLUSION: While frailty remains an important clinical consideration in early postoperative vulnerability, preoperative vitamin D status may serve as a biochemical marker of underlying physiological vulnerability. The lack of association between VDD and short-term outcomes in this cohort suggests that vitamin D status alone may not predict acute postoperative outcomes. Nevertheless, routine assessment and correction of vitamin D remain important for long-term musculoskeletal health, mobility recovery, and secondary fracture prevention within the Fracture Liaison Service (FLS) framework.
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