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This is a prospective multicenter observational cohort study design. Patients aged 50 years or older treated for hip fracture (<jats:italic>n<\/jats:italic>\u2009=\u2009245) were taken from Orthopedic wards in one medical center (<jats:italic>n<\/jats:italic>\u2009=\u2009131) and one district hospital (<jats:italic>n<\/jats:italic>\u2009=\u2009114) in Changhua County, Taiwan. Frailty was defined as measured by the validated Clinical Frailty Scale and categorized as robust, pre-frail, and frail. We used Kaplan-Meier analysis to estimate survival rates and Cox regression to estimate the risk of frailty associated with adverse outcomes. To examine the longitudinal associations between frailty and adverse outcome, the cross-lagged models were explored. Of the 245 patients, 55 (22.4%) were classified as frail, 113 (46.1%) as pre-frail, and 77 (31.4%) as robust. More cumulative events occurred for frail than for robust patients for each adverse outcome. Frailty has long-term effect on each adverse outcome after discharge, rather than the effect simultaneously. Targeting pre-frailty and frailty is essential for prevent adverse outcomes and improving the overall health of older adults after discharge for hip fracture.<\/jats:p>","DOI":"10.1038\/s41598-019-55459-2","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T11:04:00Z","timestamp":1576235040000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":92,"title":["Frailty is Associated with an Increased Risk of Major Adverse Outcomes in Elderly Patients Following Surgical Treatment of Hip Fracture"],"prefix":"10.1038","volume":"9","author":[{"given":"Chiu-Liang","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Min","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Yi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Wei","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Hwan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Pu","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herng-Chia","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,13]]},"reference":[{"key":"55459_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.afos.2018.03.003","volume":"4","author":"CL Cheung","year":"2018","unstructured":"Cheung, C. 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