Abstract
Background
The purpose of this study is to evaluate the 5-factor modified frailty index (mFI-5)
as a predictor of postoperative complications, readmission, and mortality in patients
undergoing revision hip and knee arthroplasty.
Methods
A retrospective analysis of the American College of Surgeon’s National Surgical Quality
Improvement Program’s database for patients undergoing revision total hip arthroplasty
(rTHA) and revision total knee arthroplasty (rTKA) between the years 2005 and 2016
was conducted. The 5-factor score, which includes 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
In total, 13,948 patients undergoing rTHA and 16,304 patients undergoing rTKA were
identified. The mFI-5 was a strong predictor of serious medical complications (cardiac
arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis,
reintubation, and prolonged ventilator requirement), discharge to a facility, total
length of stay, readmission, and mortality (P ≤ .007).
Conclusion
The mFI-5 predicts serious medical complications, increased length of stay, discharge
to a facility, hospital readmission, and mortality in patients undergoing rTHA and
rTKA. All the variables within the mFI-5 are easily obtained through the patient history,
allowing for a practical clinical tool that hospitals and physicians can use to identify
at-risk patients, educate and engage patients and their families in a shared decision-making
conversation, and guide perioperative care in order to optimize patient outcomes.
Level of Evidence
III.
Keywords
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Article Info
Publication History
Published online: March 06, 2019
Accepted:
February 27,
2019
Received in revised form:
February 13,
2019
Received:
December 17,
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.2019.02.060.
Identification
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