The age-adjusted Charlson comorbidity index in acetabular fracture in geriatric acetabular fractures.

Objective: This study aimed to analyze factors of comorbidity in older patients with acetabular fracture to know the role of disease in the treatment of this population.

Methods: Design: retrospective cohort study.

Setting: Single Level 2 Trauma Center.

Patient selection criteria: A prospective database of acetabular fractures in patients over 55 years between January 2011 and January 2021 was studied. The exclusion criteria were age, pathological fracture, associated pelvic or hip fracture, follow-up of less than one year, and not having a computed tomography.

Outcome measures and comparisons: Patients were categorised as low (0-2), intermediate (3-4) or high (≥5) risk according to the age-adjusted Charlson comorbidity index (ACCI). The primary outcomes were risk of complications, number of complications and mortality at one year according to the ACCI scale. The difference between the pre-fracture Clinical Frailty Scale (CFS) and the one-year follow-up was also analysed. Descriptive and multivariable regression analyses were performed and ROC curves were constructed.

Results: A total of 119 patients with acetabular fracture were collected. Ninety-eight out of those met inclusion criteria for our study. In regard to ACCI groups, 22% were low-risk, 26% were intermediate-risk, and 52% were high-risk. Statistically significant differences were found according to age, sex, mechanism of injury, treatment type, surgical treatment type, Clinical Frailty Scale (CFS) score, readmissions, complications, and mortality. ROC curves showed an association between ACCI and CFS in terms of complications and mortality, with the exception of unadjusted Charlson comorbidity index. On the multivariable regression analysis, associations were found between ACCI and presence of complications (OR 1.37, 95% CI 1.06-1.77, p=0.015) and mortality (OR 1.32, 95% CI 1.04-1.67, p=0.025) and between CFS and complications (OR 2.01, 95% CI 1.30-3.11, p=0.001) and mortality (OR 1.59, 95% CI 1.08-2.35, p=0.019). No statistical correlation was established between ASA and complications or mortality.

Conclusion: Presurgical ACCI and CFS scales may serve as a risk assessment method in treatment decision-making for patients with acetabular fracture. An association is observed between patients with a pre-fracture ACCI score ≥5 (high-risk) and a pre-fracture CFS score >4 (mild frailty) and mortality and complications at one year.