Complications - Other
New 5-Factor Modified Frailty Index Predicts Morbidity and Mortality in Primary Hip and Knee Arthroplasty

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Abstract

Background

While the 11-factor modified frailty index (mFI) has been shown to predict adverse outcomes in patients undergoing total joint arthroplasty, the 5-factor index has not been evaluated in this patient population. The goal of this study was to evaluate the utility of the mFI-5 as a predictor of morbidity and mortality in patients undergoing primary total hip and knee arthroplasty.

Methods

A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program's database for patients undergoing total hip arthroplasty and total knee arthroplasty between the years 2005 and 2016 was conducted. The 5-factor score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables.

Results

One hundred forty thousand one hundred fifty-eight patients undergoing total hip arthroplasty and 226,398 patients undergoing total knee arthroplasty were identified. After adjusting for demographic variables and comorbid conditions, logistic regression analyses revealed that the mFI-5 was a strong predictor for total complications, Clavien-Dindo grade IV complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), surgical site infections, readmission, and 30-day mortality (P < .001).

Conclusions

The mFI-5 is an independent predictor of postoperative complications including life-threatening medical complications, surgical site infections, hospital readmission, and 30-day mortality after primary hip and knee arthroplasty. This clinical tool can be used to identify high-risk surgical patients and guide preoperative counseling to optimize outcomes.

Level of Evidence

III.

Section snippets

Methods

The checklist of Haider et al [15] for the elevation of surgical database research was used throughout the design of this study. The ACS NSQIP database was selected as the most appropriate for evaluating this hypothesis. The NSQIP is a national database that collects patient data from over 600 participating hospitals. Patient demographics and their perioperative course from the date of surgery to postop day 30 is included in the database. The data are then deidentified before being shared with

Total Hip Arthroplasty

One hundred forty thousand one hundred fifty-eight patients undergoing primary total hip arthroplasty (THA) between the years 2005 and 2016 were identified. Patient characteristics are outlined in Table 1. The average patient age was 64.8 years, and 55.2% were male. Most patients had an ASA class of 2 or 3, at 53.3% and 40.5%, and a BMI between 18.5 and 34.9 (Table 1).

Baseline complication rates were calculated for all patients undergoing THA (n = 140,158, Table 2). The overall risk for any

Discussion

This is the first study to examine the utility of the mFI-5 in patients undergoing total hip and knee arthroplasty. These results suggest that the mFI-5 is an effective tool for predicting complications including life-threatening medical complications, surgical site infections, readmission, and mortality in this patient population.

Previous studies looking solely at the mFI-11 in this patient population have concluded similar results [12], [13], [14]. In a study by Shin et al [12], 39,806

Conclusions

This study demonstrates that the mFI-5 is an effective predictor of morbidity and mortality in patients undergoing total hip and knee arthroplasty. This clinical tool can be used by hospitals and surgeons to identify high-risk surgical candidates and guide preoperative counseling in order to optimize patient outcomes.

References (26)

  • N.T. Ondeck et al.

    Discriminative ability for adverse outcomes after surgical management of hip fractures

    J Orthop Trauma

    (2018)
  • M.E. Menendez et al.

    A comparison of the Charlson and Elixhauser comorbidity measures to predict inpatient mortality after proximal humerus fracture

    J Orthop Trauma

    (2015)
  • S.D. Searle et al.

    A standard procedure for creating a frailty index

    BMC Geriatr

    (2008)
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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.09.040.

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