The following is a summary of “Failure to Rescue in Geriatric Ground-Level Falls: The Role of Frailty on Not-So-Minor Injuries,” published in the October 2024 issue of Surgery by Hejazi et al.

Failure to rescue (FTR), defined as mortality following a major complication, is a critical measure of the quality of care trauma centers provide. However, the influence of patient-specific factors, particularly frailty, on the incidence of FTR among geriatric trauma patients remains inadequately studied. This study aimed to investigate the impact of frailty on FTR rates among elderly patients who experienced ground-level falls (GLFs), a common mechanism of injury in this population.

Researchers conducted a retrospective analysis using data from the American College of Surgeons Trauma Quality Improvement Program (2017–2020). The study included patients with Geriatric Trauma (aged ≥ 65 years) admitted to level I trauma centers following GLFs. Exclusion criteria included patients with severe head injuries (abbreviated injury scale ≥ 3), those who died within 24 hours of admission, transferred patients, and those with a length of stay ≤ 1 day. FTR was defined as death following major complications, including cardiac arrest, myocardial infarction, sepsis, acute respiratory distress syndrome, unplanned intubation, acute renal failure, cerebrovascular accident, ventilator-associated pneumonia, or pulmonary embolism. Patients were classified as frail (F) or non-frail (NF) using the 11-/Factor Modified Frailty Index. Multivariable regression analysis was employed to determine the independent effect of frailty on the incidence of FTR.

A total of 34,100 geriatric patients with GLFs were identified over the four-year study period, with 9,140 (26.8%) classified as frail. The cohort’s mean age was 78 years, and 65% were female. The median injury severity score was 9, with no significant difference between the frail and non-frail groups. Frail patients demonstrated a significantly higher likelihood of developing major complications (3.6% vs. 2%, P < 0.001) and experiencing FTR (1.8% vs. 0.6%, P < 0.001). Among those who developed major complications, frail patients had a substantially higher mortality rate (47% vs. 27%, P < 0.001). Multivariable regression analysis confirmed that frailty was an independent predictor of both major complications (adjusted odds ratio [AOR] 1.98, 95% CI 1.70–2.29, P < 0.001) and FTR (AOR 2.26, 95% CI 1.68–3.05, P < 0.001).

In conclusion, frailty significantly increases the risk of FTR among patients with Geriatric Trauma with GLFs, doubling the likelihood of death following major complications. Efforts to mitigate this risk should focus on optimizing both patient-specific factors and hospital-related interventions to improve outcomes in this vulnerable population.

Source: sciencedirect.com/science/article/abs/pii/S0022480424004803