Association Between Multidimensional Frailty and Postoperative Outcomes in Older Patients With Hip Fracture: A Scoping Review

Objectives

Hip fractures represent a common injury resulting from falls among older adults, significantly impairing their mobility and independence in daily activities, and substantially increasing mortality risk. Recent research has demonstrated that frailty is closely associated with postoperative adverse outcomes in older patients with hip fracture. However, most existing studies focus predominantly on single-dimensional frailty assessments, which lack comprehensive insight into the integrated impact of multidimensional frailty on postoperative outcomes. Thus, this review systematically summarizes the associations between multidimensional frailty and postoperative adverse outcomes, and examines the current application and effectiveness of multidimensional frailty assessment tools in older patients with hip fracture.

Design

A scoping review that focuses on the association between multidimensional frailty and postoperative adverse outcomes among older patients with hip fracture.

Setting and Participants

Original studies related to multidimensional frailty in older patients with hip fracture.

Methods

A comprehensive literature search was performed using databases, including PubMed, Embase, Cochrane, Web of Science, CINAHL, and PsyInfo. Studies were selected according to predefined inclusion and exclusion criteria. The basic characteristics, study designs, frailty dimensions, assessment tools, and postoperative outcomes of the included studies were extracted and analyzed.

Results

A total of 21 studies were included, predominantly retrospective and prospective cohort studies, with a noticeable increase in recent publications. The multidimensional frailty assessment tools varied significantly among studies, ranging from widely used tools to newly developed instruments. Physical, cognitive, psychological, and nutritional dimensions were most frequently addressed; however, the combination and selection of these dimensions varied across studies. Postoperative outcomes mainly focused on mortality, poor functional recovery, postoperative complications, and rehospitalization. Multidimensional frailty assessment tools consistently demonstrated superior predictive performance compared with single-dimensional measures.

Conclusions and Implications

Multidimensional frailty exhibits significant predictive value for adverse postoperative outcomes in older patients with hip fracture, supporting the widespread clinical implementation of early identification and intervention strategies. These findings underscore the need for integrating frailty assessment into routine preoperative evaluation to guide risk stratification and personalized perioperative care. However, because of the lack of standardized frailty assessment tools, further prospective and high-quality studies are warranted to validate and refine their applicability and effectiveness.