The relationship between rectus abdominis muscle thickness and frailty in geriatric patients with femur fractures

Frailty is commonly observed in the geriatric population and is clinically significant. Frailty is a multidimensional and dynamic condition characterized by declines in reserve and function across multiple physiological systems. As a result, when exposed to stressors, the ability of older individuals to maintain bodily homeostasis is compromised. The decline in muscle mass and function—also known as sarcopenia—plays a key role in the development of frailty. Therefore, sarcopenia is expected in many muscle groups, including the rectus abdominis, in frail individuals. This study aimed to determine the relationship between rectus abdominis muscle thickness and frailty in geriatric patients scheduled for surgery due to femoral fractures. This study was conducted at Gaziosmanpaşa University Faculty of Medicine Hospital between 01/06/2024 and 01/12/2024 with 82 patients who met the inclusion and exclusion criteria. Preoperative ultrasonographic measurements of the rectus abdominis and rectus femoris muscle thicknesses were performed on patients with femoral fractures who were scheduled for surgery by the Orthopedics and Traumatology department. The frailty status of the patients was assessed using the Edmonton Frail Scale. Upon admission to the intensive care unit, APACHE II, SOFA, and NRS-2002 scores were recorded. As a result of the study, the right, left, and average rectus abdominis muscle thicknesses were found to be significantly thinner in the frail group (p<0.001). Rectus femoris muscle thickness was also significantly thinner in the frail group (p<0.001). When examining the 1-month mortality rates, mortality in the frail group was 19.5%, while it was 4.9% in the non-frail group; this difference was statistically significant (p=0.043). When evaluating length of stay, both ICU stay and total hospitalization duration were significantly longer in the frail group (p=0.042, p=0.023). The frailty rate among patients who died was found to be 80%, which was significantly higher compared to those who survived (p=0.043). Although muscle thickness measurements—including right, left, and average rectus abdominis and rectus femoris—were lower in patients who died, the differences were not statistically significant (p>0.05). When comparing scoring systems, APACHE II, SOFA, and NRS-2002 scores were found to be significantly higher in the frail group compared to the non-frail group (p<0.001). This study showed that preoperative muscle thickness assessment with ultrasonography is reliable and easily applicable. This shows that muscle thickness measurement by ultrasonography is useful in clinical use.