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Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Hip Arthroplasty.
J Arthroplasty. 2017 10; 32(10):2963-2968.JA

Abstract

BACKGROUND

Frailty is described as decreased physiological reserve and typically increasing with age. Hospitals are being penalized for reoperations and readmissions, which can affect reimbursement. The purpose of this study was to determine if the modified frailty index (MFI) could be used as a risk assessment tool for preoperative counseling and to make an objective decision on whether to perform total hip arthroplasty (THA) on a frail patient.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database was queried by Current Procedural Terminology code for primary THA (27130) from 2005 to 2014. MFI was calculated using 11 variables extracted from the medical record. Bivariate analysis was performed for outcomes and complications, and the multiple logistic regression model was used to compare MFI with other predictors of readmission, any complication, and reoperation.

RESULTS

A total of 51,582 patients underwent primary THA during the study period. MFI was a significant and stronger predictor than the American Society of Anesthesiologists class and age for readmission (odds ratio [OR], 14.72; 95% confidence interval [CI], 6.95-31.18; P < .001), any complication (OR, 3.63; 95% CI, 1.64-8.05; P = .002), and reoperation (OR, 8.78; 95% CI, 3.67-20.98; P < .001). As MFI increased, adverse discharge, any complication, readmission, reoperation, and mortality significantly increased (P < .001). Rates of systemic complications and length of stay significantly increased with increasing MFI.

CONCLUSION

MFI is a simple and effective risk assessment tool to preoperatively counsel and make an objective decision on whether to perform THA on a frail patient.

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28559198

Citation

Bellamy, Jaime L., et al. "Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Hip Arthroplasty." The Journal of Arthroplasty, vol. 32, no. 10, 2017, pp. 2963-2968.
Bellamy JL, Runner RP, Vu CCL, et al. Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Hip Arthroplasty. J Arthroplasty. 2017;32(10):2963-2968.
Bellamy, J. L., Runner, R. P., Vu, C. C. L., Schenker, M. L., Bradbury, T. L., & Roberson, J. R. (2017). Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Hip Arthroplasty. The Journal of Arthroplasty, 32(10), 2963-2968. https://doi.org/10.1016/j.arth.2017.04.056
Bellamy JL, et al. Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Hip Arthroplasty. J Arthroplasty. 2017;32(10):2963-2968. PubMed PMID: 28559198.
* 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 Hip Arthroplasty. AU - Bellamy,Jaime L, AU - Runner,Robert P, AU - Vu,CatPhuong Cathy L, AU - Schenker,Mara L, AU - Bradbury,Thomas L, AU - Roberson,James R, Y1 - 2017/05/04/ PY - 2017/02/10/received PY - 2017/04/15/revised PY - 2017/04/25/accepted PY - 2017/6/1/pubmed PY - 2018/4/24/medline PY - 2017/6/1/entrez KW - complication KW - frailty KW - mortality KW - readmission KW - reoperation KW - total hip arthroplasty SP - 2963 EP - 2968 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 10 N2 - BACKGROUND: Frailty is described as decreased physiological reserve and typically increasing with age. Hospitals are being penalized for reoperations and readmissions, which can affect reimbursement. The purpose of this study was to determine if the modified frailty index (MFI) could be used as a risk assessment tool for preoperative counseling and to make an objective decision on whether to perform total hip arthroplasty (THA) on a frail patient. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried by Current Procedural Terminology code for primary THA (27130) from 2005 to 2014. MFI was calculated using 11 variables extracted from the medical record. Bivariate analysis was performed for outcomes and complications, and the multiple logistic regression model was used to compare MFI with other predictors of readmission, any complication, and reoperation. RESULTS: A total of 51,582 patients underwent primary THA during the study period. MFI was a significant and stronger predictor than the American Society of Anesthesiologists class and age for readmission (odds ratio [OR], 14.72; 95% confidence interval [CI], 6.95-31.18; P < .001), any complication (OR, 3.63; 95% CI, 1.64-8.05; P = .002), and reoperation (OR, 8.78; 95% CI, 3.67-20.98; P < .001). As MFI increased, adverse discharge, any complication, readmission, reoperation, and mortality significantly increased (P < .001). Rates of systemic complications and length of stay significantly increased with increasing MFI. CONCLUSION: MFI is a simple and effective risk assessment tool to preoperatively counsel and make an objective decision on whether to perform THA on a frail patient. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28559198/Modified_Frailty_Index_Is_an_Effective_Risk_Assessment_Tool_in_Primary_Total_Hip_Arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(17)30397-2 DB - PRIME DP - Unbound Medicine ER -