Inflammatory Indices, Early Mortality, and ICU Stay in Geriatric PFN Patients (PFN-RAR)

Association of Preoperative and Postoperative Inflammatory Indices With 30-Day Mortality and Intensive Care Unit Length of Stay in Geriatric Patients Undergoing Proximal Femoral Nailing: A Retrospective Observational Cohort Study

This retrospective observational cohort study aims to evaluate the association between preoperative and postoperative inflammatory indices and early postoperative outcomes in geriatric patients undergoing proximal femoral nailing (PFN) for intertrochanteric femur fractures. The primary outcome of the study is 30-day mortality, while the secondary outcome is intensive care unit (ICU) length of stay. Various inflammatory biomarkers derived from routine laboratory parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), immune-inflammatory prognostic index (IPI), aggregate index of systemic inflammation (AIS), and RDW-to-albumin ratio (RAR), will be analyzed to investigate their prognostic value in the acute postoperative period. The study seeks to identify simple and readily accessible biomarkers that may contribute to early risk stratification and perioperative management in elderly hip fracture patients.

Study Overview

• Status: Active, not recruiting
• Conditions: Hip Fracture Surgeries; Geriatric Anesthesia; Intertrochanteric Femur Fracture

Detailed Description

Hip fractures are associated with substantial morbidity and mortality in the geriatric population. Intertrochanteric femur fractures, in particular, frequently require surgical stabilization with proximal femoral nailing (PFN). Despite advances in perioperative care, early postoperative mortality rates and intensive care utilization remain high in elderly patients undergoing PFN surgery. Identifying reliable biomarkers that reflect the acute systemic inflammatory response to surgical trauma may improve perioperative risk stratification and postoperative management.

In recent years, several hematologic inflammatory indices derived from routine laboratory parameters have emerged as potential prognostic markers in different clinical settings. These include neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AIS), immune-inflammatory prognostic index (IPI), and red cell distribution width-to-albumin ratio (RAR). However, data regarding the prognostic significance of these inflammatory indices in geriatric orthopedic trauma patients remain limited.

This retrospective observational cohort study evaluates the association between preoperative and postoperative inflammatory indices and early postoperative outcomes in geriatric patients undergoing PFN surgery for intertrochanteric femur fractures. Electronic medical records of eligible patients aged 65 years and older will be reviewed retrospectively. Demographic characteristics, comorbidities, perioperative laboratory findings, inflammatory indices, 30-day mortality, and intensive care unit (ICU) length of stay will be analyzed.

The primary outcome of the study is 30-day mortality. The secondary outcome is ICU length of stay. The study aims to determine whether inflammatory indices, particularly RDW-to-albumin ratio (RAR), are independently associated with early mortality and prolonged ICU stay in the acute postoperative period. The findings may contribute to the identification of simple and cost-effective biomarkers for early risk assessment in geriatric hip fracture patients.

• Study Type: Observational
• Enrollment (Estimated): 233

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Diyarbakır
    • Diyarbakır, Diyarbakır, Turkey (Türkiye)
      • University of Health Sciences Gazi Yaşargil Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Geriatric patients aged 65 years and older who underwent proximal femoral nailing (PFN) surgery for intertrochanteric femur fractures at a tertiary referral center were retrospectively evaluated. The study population consisted of patients with available perioperative laboratory data, 30-day mortality information, and intensive care unit follow-up records.

Description

Inclusion Criteria:

• Patients aged 65 years and older
• Diagnosis of intertrochanteric femur fracture
• Undergoing proximal femoral nailing (PFN) surgery
• Availability of preoperative laboratory data
• Availability of early postoperative laboratory measurements
• Availability of 30-day mortality data
• Availability of intensive care unit admission and ICU length of stay data
• Complete electronic medical records

Exclusion Criteria:

• Patients with missing clinical or laboratory data
• Pathological fractures
• Multiple trauma patients
• Revision surgeries
• Presence of active infection or sepsis before surgery
• Hematologic diseases that could affect inflammatory indices
• Unavailable 30-day mortality or ICU data

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Geriatric PFN Cohort; Geriatric patients aged 65 years and older who underwent proximal femoral nailing (PFN) surgery for intertrochanteric femur fractures and were retrospectively evaluated for inflammatory indices, 30-day mortality, and intensive care unit length of stay.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
30-Day Mortality	Evaluation of all-cause mortality occurring within the first 30 postoperative days in geriatric patients undergoing proximal femoral nailing surgery.	Within 30 days after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intensive Care Unit Length of Stay	ICU stay duration in days	30 days

Collaborators and Investigators

• Sponsor: Saglik Bilimleri Universitesi
• Investigators: Principal Investigator: selen topalel, MD, Department of Anesthesiology and Reanimation, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakır, Türkiye

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2021
• Primary Completion (Estimated): June 15, 2026
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: May 12, 2026
• First Submitted That Met QC Criteria: May 22, 2026
• First Posted (Actual): May 26, 2026

Study Record Updates

• Last Update Posted (Actual): May 28, 2026
• Last Update Submitted That Met QC Criteria: May 25, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Intensive Care Unit; Hip Fracture Surgery; RAR; Geriatric Patients; Early Mortality; Proximal Femoral Nailing; Inflammatory Indices; RDW-to-Albumin Ratio; PFN
• Other Study ID Numbers: GYEAH-PFN-RAR-2026-05

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No