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.
Keywords
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Article Info
Publication History
Published online: September 21, 2018
Accepted:
September 13,
2018
Received in revised form:
August 18,
2018
Received:
July 22,
2018
Footnotes
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.
Identification
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