• Nicole Huang, Teresa Cheng, Cara Joyce, Joseph Cohen, and Ashley E Levack.
• Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S First Ave, Maywood, IL, 60153, USA. nicole.huang@luhs.org.
• Arch Orthop Trauma Surg. 2024 Dec 21; 145 (1): 7777.

ObjectiveTo measure the predictive value of three perioperative risk assessment tools (National Surgical Quality Improvement Program-NSQIP, Modified 5-factor Frailty Index-mFI-5, and Score for Trauma Triage in Geriatric and Middle Aged-STTGMA) in predicting postoperative complications in older adult ankle fractures.Materials And MethodsThis is a retrospective study of surgically treated isolated older adult ankle fractures at an academic center between 2007 and 2022. Exclusion criteria included age < 55 years, presence of pathologic fractures, and having multiple orthopaedic injuries. Patient sociodemographic information, injury characteristics, clinical outcomes, and complications were obtained. Data was entered into the NSQIP, mFI-5, and STTGMA calculators. Descriptive statistics and univariable logistic regression models were calculated for each outcome of interest. Area under the receiver operative curves (AUC) were determined as a measure of tool discrimination.Results382 patients met inclusion criteria. The average age was 67 years, 33% were male, and 87% ambulated without assistive devices prior to injury. 23.6% of all patients had a complication: 12.8% had at least one minor complication, 15.7% had at least one major complication, and 2.4% had surgical complications. Mortality within 1 year of initial injury was 2.9%. NSQIP was the best predictor of any complication (AUC 0.74) compared to the mFI-5 (AUC 0.68), and STTGMA (AUC 0.72).ConclusionsNSQIP performed better than mFI-5, STTGMA, and CCI for postoperative complications and mortality, but none of the perioperative risk assessment tools performed exceptionally well in the context of isolated older adult ankle fractures.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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