{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:15:59Z","timestamp":1791195359353,"version":"4.1.0"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"31","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Non-profit Central Research Institute Fund of Beijing Hospital","award":["BJ-2018-088"],"award-info":[{"award-number":["BJ-2018-088"]}]},{"name":"National High Level Hospital Clinical Research Funding"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:p>Frailty is a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function. It is highly prevalent among older orthopedic patients and significantly increases the risk of surgery and postoperative complications. Therefore, preoperative identification of high-risk groups for postoperative frailty is crucial for optimizing clinical decision making. This study aimed to explore the predictors of persistent postoperative frailty in older patients undergoing elective orthopedic surgery. Patients aged\u2005&gt;\u200565 years who underwent elective orthopedic surgery between January 2020 and January 2022 were included in this single-center retrospective cohort study. Baseline characteristics, clinical data, laboratory findings, and frailty assessments were recorded. Persistent postoperative frailty was defined as a FRAILTY score &gt;2 at the 3-, 6-, and 12-month follow-ups. Patients were randomly divided into training and validation cohorts at a ratio of 7:3 using stratified sampling. Least absolute shrinkage and selection operator and logistic regression were used for variable screening and analysis. A nomogram was constructed to visualize the predicted model. Receiver operating characteristic curves and area under the curve (AUC) values were used to assess the diagnostic accuracy. Calibration curves were performed to evaluate the calibration. A decision curve analysis was used to evaluate the clinical utility. Grip strength, gait speed, systemic immune-inflammation index, and the systemic inflammatory response index were identified as the significant predictors. The corresponding odds ratios were 2.467, 1.214, 1.809, and 1.743, respectively. A nomogram was used to visualize the logistic model, which achieved an AUC value of 0.772 (with a sensitivity of 77.9% and specificity of 64.3%) in the training cohort and an AUC value of 0.788 (with a sensitivity of 86.1% and specificity of 82.2%) in the validation cohort. Calibration curves indicating the acceptable agreements between the nomogram-predicted probability and the actual probability of persistent postoperative frailty. The decision curve analysis curves showed that the prediction model consistently outperformed the \u201ctreat-all\u201d and \u201ctreat-none\u201d strategies. The prediction model incorporating grip strength, gait speed, systemic immune-inflammation index, and systemic inflammatory response index enables early perioperative identification of older patients undergoing elective orthopedic surgery who are at high risk for developing persistent postoperative frailty.<\/jats:p>","DOI":"10.1097\/md.0000000000043500","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T23:00:28Z","timestamp":1754089228000},"page":"e43500","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["A prediction model for persistent postoperative frailty in older patients undergoing elective orthopedic surgery"],"prefix":"10.1097","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6662-5463","authenticated-orcid":false,"given":"Guanghan","family":"Gao","sequence":"first","affiliation":[{"name":"Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zitian","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zichen","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaonan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyun","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250918","doi-asserted-by":"crossref","first-page":"4348","DOI":"10.3760\/cma.j.issn.0366-6999.20130134","article-title":"Old age security in rural China: there is a long way to go.","volume":"126","author":"Dai","year":"2013","journal-title":"Chin Med J (Engl)"},{"key":"R2-20250918","doi-asserted-by":"crossref","first-page":"111441","DOI":"10.1016\/j.mad.2021.111441","article-title":"Frailty syndrome: a target for functional nutrients?","volume":"195","author":"Davinelli","year":"2021","journal-title":"Mech Ageing Dev"},{"key":"R3-20250918","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/S0140-6736(19)31785-4","article-title":"Management of frailty: opportunities, challenges, and future directions.","volume":"394","author":"Dent","year":"2019","journal-title":"Lancet"},{"key":"R4-20250918","doi-asserted-by":"crossref","first-page":"e289","DOI":"10.1016\/j.wneu.2024.08.106","article-title":"Patient-reported physical and mental health outcomes following lumbar spinal fusion versus total hip and total knee replacement.","volume":"191","author":"Daher","year":"2024","journal-title":"World Neurosurg"},{"key":"R5-20250918","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1177\/21925682221124101","article-title":"Utility of the modified 5-items frailty index to predict complications and mortality after elective cervical, thoracic and lumbar posterior spine fusion surgery: multicentric analysis from ACS-NSQIP database.","volume":"14","author":"Camino-Willhuber","year":"2024","journal-title":"Global Spine J"},{"key":"R6-20250918","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/978-3-030-33330-0_2","article-title":"Tools for assessing frailty in older people: general concepts.","volume":"1216","author":"Martin","year":"2020","journal-title":"Adv Exp Med Biol"},{"key":"R7-20250918","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/ACO.0000000000001221","article-title":"Preoperative frailty screening, assessment and management.","volume":"36","author":"Cappe","year":"2023","journal-title":"Curr Opin Anaesthesiol"},{"key":"R8-20250918","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12877-019-1053-y","article-title":"The feasibility of assessing frailty and sarcopenia in hospitalised older people: a comparison of commonly used tools.","volume":"19","author":"Ibrahim","year":"2019","journal-title":"BMC Geriatr"},{"key":"R9-20250918","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1038\/s41569-018-0064-2","article-title":"Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty.","volume":"15","author":"Ferrucci","year":"2018","journal-title":"Nat Rev Cardiol"},{"key":"R10-20250918","doi-asserted-by":"crossref","first-page":"18966","DOI":"10.1038\/s41598-021-98359-0","article-title":"Real-world gait speed estimation, frailty and handgrip strength: a cohort-based study.","volume":"11","author":"Soltani","year":"2021","journal-title":"Sci Rep"},{"key":"R11-20250918","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.jamda.2023.01.023","article-title":"Effect of physical activity intervention on gait speed by frailty condition: a randomized clinical trial.","volume":"24","author":"Custodero","year":"2023","journal-title":"J Am Med Dir Assoc"},{"key":"R12-20250918","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.1111\/jgs.18348","article-title":"The association of gait speed and self-reported difficulty walking with social isolation: a nationally- representative study.","volume":"71","author":"Kuang","year":"2023","journal-title":"J Am Geriatr Soc"},{"key":"R13-20250918","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.2147\/CIA.S140192","article-title":"Grip strength as a frailty diagnostic component in geriatric inpatients.","volume":"12","author":"Dudzi\u0144ska-Griszek","year":"2017","journal-title":"Clin Interv Aging"},{"key":"R14-20250918","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/ageing\/afz046","article-title":"Sarcopenia: revised European consensus on definition and diagnosis.","volume":"48","author":"Cruz-Jentoft","year":"2019","journal-title":"Age Ageing"},{"key":"R15-20250918","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.jamcollsurg.2015.12.026","article-title":"Optimal perioperative management of the geriatric patient: a best practices guideline from the American college of surgeons NSQIP and the American geriatrics society.","volume":"222","author":"Mohanty","year":"2016","journal-title":"J Am Coll Surg"},{"key":"R16-20250918","doi-asserted-by":"crossref","first-page":"e537","DOI":"10.1016\/S2589-7500(20)30218-1","article-title":"Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension.","volume":"2","author":"Liu","year":"2020","journal-title":"Lancet Digit Health"},{"key":"R17-20250918","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1038\/s41591-020-0941-1","article-title":"Developing specific reporting guidelines for diagnostic accuracy studies assessing AI interventions: the STARD-AI steering group.","volume":"26","author":"Sounderajah","year":"2020","journal-title":"Nat Med"},{"key":"R18-20250918","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.","volume":"21","author":"Chen","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"R19-20250918","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1007\/s40620-022-01436-4","article-title":"Transitions in frailty state 12 months after kidney transplantation: a prospective cohort study.","volume":"35","author":"Dos Santos Mantovani","year":"2022","journal-title":"J Nephrol"},{"key":"R20-20250918","doi-asserted-by":"crossref","first-page":"6212","DOI":"10.1158\/1078-0432.CCR-14-0442","article-title":"Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma.","volume":"20","author":"Hu","year":"2014","journal-title":"Clin Cancer Res"},{"key":"R21-20250918","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1002\/cncr.30057","article-title":"A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy.","volume":"122","author":"Qi","year":"2016","journal-title":"Cancer"},{"key":"R22-20250918","doi-asserted-by":"crossref","first-page":"9553","DOI":"10.3390\/ijms23179553","article-title":"Investigation of the associations of novel inflammatory biomarkers-systemic inflammatory index (SII) and systemic inflammatory response index (SIRI)-with the severity of coronary artery disease and acute coronary syndrome occurrence.","volume":"23","author":"Dziedzic","year":"2022","journal-title":"Int J Mol Sci"},{"key":"R23-20250918","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.3390\/jcm12031128","article-title":"Systemic immune inflammation index (SII), system inflammation response index (SIRI) and risk of all-cause mortality and cardiovascular mortality: a 20-Year follow-up cohort study of 42,875 US adults.","volume":"12","author":"Xia","year":"2023","journal-title":"J Clin Med"},{"key":"R24-20250918","doi-asserted-by":"crossref","first-page":"1377408","DOI":"10.3389\/fpubh.2024.1377408","article-title":"Association of two novel systemic inflammatory biomarkers and frailty based on NHANES 2007-2018.","volume":"12","author":"Zhang","year":"2024","journal-title":"Front Public Health"},{"key":"R25-20250918","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jamda.2013.03.022","article-title":"Frailty consensus: a call to action.","volume":"14","author":"Morley","year":"2013","journal-title":"J Am Med Dir Assoc"},{"key":"R26-20250918","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1002\/sim.7992","article-title":"Minimum sample size for developing a multivariable prediction model: pART II - binary and time-to-event outcomes.","volume":"38","author":"Riley","year":"2019","journal-title":"Stat Med"},{"key":"R27-20250918","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jen.2023.08.008","article-title":"Frailty knowledge, use of screening tools, and educational challenges in emergency departments in ireland: a multisite survey.","volume":"50","author":"Moloney","year":"2024","journal-title":"J Emerg Nurs"},{"key":"R28-20250918","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/ANA.0000000000000787","article-title":"Frailty assessment and prehabilitation before complex spine surgery in patients with degenerative spine disease: a narrative review.","volume":"35","author":"Mohamed","year":"2023","journal-title":"J Neurosurg Anesthesiol"},{"key":"R29-20250918","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1001\/jamasurg.2016.4219","article-title":"Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days.","volume":"152","author":"Hall","year":"2017","journal-title":"JAMA Surg"},{"key":"R30-20250918","doi-asserted-by":"crossref","first-page":"237","DOI":"10.3928\/01477447-20160610-01","article-title":"Patient comorbidity status and incremental total hospitalization costs in elective orthopedic procedures.","volume":"39","author":"Nichols","year":"2016","journal-title":"Orthopedics"},{"key":"R31-20250918","doi-asserted-by":"crossref","first-page":"1110648","DOI":"10.3389\/fpubh.2023.1110648","article-title":"Prevalence and factors associated with frailty and pre-frailty in the older adults in China: a national cross-sectional study.","volume":"11","author":"Zeng","year":"2023","journal-title":"Front Public Health"},{"key":"R32-20250918","doi-asserted-by":"crossref","first-page":"afac311","DOI":"10.1093\/ageing\/afac311","article-title":"Physical frailty, adherence to ideal cardiovascular health and risk of cardiovascular disease: a prospective cohort study.","volume":"52","author":"Chen","year":"2023","journal-title":"Age Ageing"},{"key":"R33-20250918","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00430-019-00591-z","article-title":"T-cell immunity against cytomegalovirus in HIV infection and aging: relationships with inflammation, immune activation, and frailty.","volume":"208","author":"Tavenier","year":"2019","journal-title":"Med Microbiol Immunol"},{"key":"R34-20250918","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s12979-023-00391-3","article-title":"Frailty is related to serum inflammageing markers: results from the VITAL study.","volume":"20","author":"Van Sleen","year":"2023","journal-title":"Immun Ageing"},{"key":"R35-20250918","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s00701-017-3384-9","article-title":"Medical complications and mortality in octogenarians undergoing elective spinal fusion surgeries.","volume":"160","author":"Rajpal","year":"2018","journal-title":"Acta Neurochir (Wien)"},{"key":"R36-20250918","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.immuni.2006.05.001","article-title":"Aging of the immune system: how much can the adaptive immune system adapt?","volume":"24","author":"Weng","year":"2006","journal-title":"Immunity"},{"key":"R37-20250918","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1111\/acel.12114","article-title":"An age-related numerical and functional deficit in CD19(+) CD24(hi) CD38(hi) B cells is associated with an increase in systemic autoimmunity.","volume":"12","author":"Duggal","year":"2013","journal-title":"Aging Cell"},{"key":"R38-20250918","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1016\/j.jaci.2009.09.017","article-title":"Adaptive immunity.","volume":"125","author":"Bonilla","year":"2010","journal-title":"J Allergy Clin Immunol"},{"key":"R39-20250918","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s10654-018-0472-y","article-title":"The neutrophil-to-lymphocyte ratio is associated with mortality in the general population: the Rotterdam study.","volume":"34","author":"Fest","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"R40-20250918","doi-asserted-by":"crossref","first-page":"10760296221146183","DOI":"10.1177\/10760296221146183","article-title":"The prognostic value of hematologic inflammatory markers in patients with acute coronary syndrome undergoing percutaneous coronary intervention.","volume":"28","author":"Fan","year":"2022","journal-title":"Clin Appl Thromb Hemost"},{"key":"R41-20250918","doi-asserted-by":"crossref","first-page":"1066219","DOI":"10.3389\/fcvm.2022.1066219","article-title":"Inflammation index SIRI is associated with increased all-cause and cardiovascular mortality among patients with hypertension.","volume":"9","author":"Zhao","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"R42-20250918","first-page":"1","article-title":"National health and nutrition examination survey: plan and operations, 1999\u20132010.","volume":"56","author":"Zipf","year":"2013","journal-title":"Vital Health Stat 1"},{"key":"R43-20250918","doi-asserted-by":"crossref","first-page":"5059","DOI":"10.2147\/JIR.S327014","article-title":"Diagnostic and prognostic value of immune\/inflammation biomarkers for venous thromboembolism: is it reliable for clinical practice?","volume":"14","author":"Xue","year":"2021","journal-title":"J Inflamm Res"},{"key":"R44-20250918","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people.","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet (Lond)"},{"key":"R45-20250918","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.cell.2005.01.027","article-title":"Understanding the odd science of aging.","volume":"120","author":"Kirkwood","year":"2005","journal-title":"Cell"},{"key":"R46-20250918","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/TA.0000000000003817","article-title":"Prospective validation and application of the trauma-specific frailty index: results of an American association for the surgery of trauma multi-institutional observational trial.","volume":"94","author":"Joseph","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"R47-20250918","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/ACO.0000000000001006","article-title":"Perioperative frailty: lessons learned and future directions.","volume":"34","author":"Adeleke","year":"2021","journal-title":"Curr Opin Anaesthesiol"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000043500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T22:00:25Z","timestamp":1758232825000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000043500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":47,"journal-issue":{"issue":"31","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000043500","relation":{},"ISSN":["1536-5964"],"issn-type":[{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]}}}