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Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Knee Arthroplasty.
J Arthroplasty. 2017 09; 32(9S):S177-S182.JA

Abstract

BACKGROUND

"Frailty" is a marker of physiological decline of multiple organ systems, and the frailty index identifies patients who are more susceptible to postoperative complications. The purpose of this study is to validate the modified frailty index (MFI) as a predictor of postoperative complications, reoperations, and readmissions in patients who underwent primary total knee arthroplasty (TKA).

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2014 was queried by the Current Procedural Terminology code for primary TKA (27447). A previously described MFI was used to summate 11 variables in 5 organ systems. Bivariate analysis was performed for postoperative complications. A multiple logistic regression model was used to determine the relationship between MFI, American Society of Anesthesiologists score, and 30-day reoperation, controlling for age, gender, and body mass index.

RESULTS

A total of 90,260 patients underwent primary TKA during the study period. As MFI score increased, 30-day mortality significantly increased (P < .001). In addition, significantly higher rates of postoperative complications (all P < .001) were observed with increasing MFI: infection, wound, cardiac, pulmonary, and renal complications; and any occurrence. More frail patients also had increasing odds of adverse hospital discharge disposition, reoperation, and readmission (all P < .001). Length of hospital stay increased from 3.10 to 5.16 days (P < .001), while length of intensive care unit stay increased from 3.47 to 5.07 days (P < .001) between MFI score 0 and ≥0.36. MFI predicts 30-day reoperation with an adjusted odds ratio of 3.32 (95% confidence interval, 1.36-8.11; P < .001). Comparatively, MFI was a stronger predictor of reoperation compared with American Society of Anesthesiologists score and age with adjustment for gender and body mass index.

CONCLUSION

Utilization of the MFI is a valid method in predicting postoperative complications, reoperations, and readmissions in patients undergoing primary TKA and can provide an effective and robust risk assessment tool to appropriately counsel patients and aid in preoperative optimization.

Authors+Show Affiliations

Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia; Department of Orthopaedics, Grady Memorial Hospital, Atlanta, Georgia.Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28442185

Citation

Runner, Robert P., et al. "Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Knee Arthroplasty." The Journal of Arthroplasty, vol. 32, no. 9S, 2017, pp. S177-S182.
Runner RP, Bellamy JL, Vu CCL, et al. Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Knee Arthroplasty. J Arthroplasty. 2017;32(9S):S177-S182.
Runner, R. P., Bellamy, J. L., Vu, C. C. L., Erens, G. A., Schenker, M. L., & Guild, G. N. (2017). Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Knee Arthroplasty. The Journal of Arthroplasty, 32(9S), S177-S182. https://doi.org/10.1016/j.arth.2017.03.046
Runner RP, et al. Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Knee Arthroplasty. J Arthroplasty. 2017;32(9S):S177-S182. PubMed PMID: 28442185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Knee Arthroplasty. AU - Runner,Robert P, AU - Bellamy,Jaime L, AU - Vu,CatPhuong Cathy L, AU - Erens,Greg A, AU - Schenker,Mara L, AU - Guild,George N,3rd Y1 - 2017/03/29/ PY - 2016/12/20/received PY - 2017/02/10/revised PY - 2017/03/20/accepted PY - 2017/4/27/pubmed PY - 2018/4/18/medline PY - 2017/4/27/entrez KW - TKA KW - complications KW - frailty KW - modified frailty index KW - primary total knee arthroplasty KW - risk stratification SP - S177 EP - S182 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 9S N2 - BACKGROUND: "Frailty" is a marker of physiological decline of multiple organ systems, and the frailty index identifies patients who are more susceptible to postoperative complications. The purpose of this study is to validate the modified frailty index (MFI) as a predictor of postoperative complications, reoperations, and readmissions in patients who underwent primary total knee arthroplasty (TKA). METHODS: The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2014 was queried by the Current Procedural Terminology code for primary TKA (27447). A previously described MFI was used to summate 11 variables in 5 organ systems. Bivariate analysis was performed for postoperative complications. A multiple logistic regression model was used to determine the relationship between MFI, American Society of Anesthesiologists score, and 30-day reoperation, controlling for age, gender, and body mass index. RESULTS: A total of 90,260 patients underwent primary TKA during the study period. As MFI score increased, 30-day mortality significantly increased (P < .001). In addition, significantly higher rates of postoperative complications (all P < .001) were observed with increasing MFI: infection, wound, cardiac, pulmonary, and renal complications; and any occurrence. More frail patients also had increasing odds of adverse hospital discharge disposition, reoperation, and readmission (all P < .001). Length of hospital stay increased from 3.10 to 5.16 days (P < .001), while length of intensive care unit stay increased from 3.47 to 5.07 days (P < .001) between MFI score 0 and ≥0.36. MFI predicts 30-day reoperation with an adjusted odds ratio of 3.32 (95% confidence interval, 1.36-8.11; P < .001). Comparatively, MFI was a stronger predictor of reoperation compared with American Society of Anesthesiologists score and age with adjustment for gender and body mass index. CONCLUSION: Utilization of the MFI is a valid method in predicting postoperative complications, reoperations, and readmissions in patients undergoing primary TKA and can provide an effective and robust risk assessment tool to appropriately counsel patients and aid in preoperative optimization. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28442185/Modified_Frailty_Index_Is_an_Effective_Risk_Assessment_Tool_in_Primary_Total_Knee_Arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(17)30282-6 DB - PRIME DP - Unbound Medicine ER -