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Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures.
J Hand Surg Am. 2018 08; 43(8):701-709.JH

Abstract

PURPOSE

Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries. We hypothesized that this index would predict, and might ultimately prevent, complications in patients older than 50 years with distal radius fractures.

METHODS

We retrospectively reviewed the American College of Surgeons-National Surgery Quality Improvement Program (ACS-NSQIP) database, including patients older than 50 years who underwent open reduction and internal fixation of a distal radius fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates, as well as length of stay (LOS) were recorded. Bivariate and multivariable statistical analysis was then performed.

RESULTS

We identified 6,494 patients (mean age, 65 years). Compared with patients with mFI of 0, patients with mFI of 2 or greater were nearly 2.5 times as likely to incur a postoperative complication (1.7% vs 7.4%). Specifically, the rates of Clavien-Dindo IV, wound, cardiac, and renal complications were increased significantly in patients with mFI of 2 or greater. In addition, as mFI increased from 0 to 2 or greater, 30-day reoperation rate increased from 0.8% to 2.4%, 30-day readmission from 0.8% to 4.6%, and LOS from 0.5 days to 1.44 days. Frailty was associated with increased complications as well as rates of readmission and reoperation even when controlling for demographic data, LOS, and operative time. Age alone was not significantly associated with postoperative complications, readmission, reoperation, or LOS.

CONCLUSIONS

A state of frailty is highly predictive of postoperative complications, readmission, reoperation, and increased LOS following open reduction and internal fixation of distal radius fractures. Our data suggest that a simple frailty evaluation can help inform surgical decision making in patients older than 50 years with distal radius fractures.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Authors+Show Affiliations

Emory University Orthopedics and Spine, Atlanta, GA.Emory University Orthopedics and Spine, Atlanta, GA.Emory University Orthopedics and Spine, Atlanta, GA.Emory University Orthopedics and Spine, Atlanta, GA.Emory University Orthopedics and Spine, Atlanta, GA. Electronic address: clifton.meals@emory.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29980394

Citation

Wilson, Jacob M., et al. "Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures." The Journal of Hand Surgery, vol. 43, no. 8, 2018, pp. 701-709.
Wilson JM, Holzgrefe RE, Staley CA, et al. Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures. J Hand Surg Am. 2018;43(8):701-709.
Wilson, J. M., Holzgrefe, R. E., Staley, C. A., Schenker, M. L., & Meals, C. G. (2018). Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures. The Journal of Hand Surgery, 43(8), 701-709. https://doi.org/10.1016/j.jhsa.2018.05.029
Wilson JM, et al. Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures. J Hand Surg Am. 2018;43(8):701-709. PubMed PMID: 29980394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures. AU - Wilson,Jacob M, AU - Holzgrefe,Russell E, AU - Staley,Christopher A, AU - Schenker,Mara L, AU - Meals,Clifton G, Y1 - 2018/07/03/ PY - 2017/10/24/received PY - 2018/05/16/accepted PY - 2018/7/8/pubmed PY - 2019/5/17/medline PY - 2018/7/8/entrez KW - Complications KW - distal radius KW - frailty KW - length of stay KW - readmission SP - 701 EP - 709 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 43 IS - 8 N2 - PURPOSE: Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries. We hypothesized that this index would predict, and might ultimately prevent, complications in patients older than 50 years with distal radius fractures. METHODS: We retrospectively reviewed the American College of Surgeons-National Surgery Quality Improvement Program (ACS-NSQIP) database, including patients older than 50 years who underwent open reduction and internal fixation of a distal radius fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates, as well as length of stay (LOS) were recorded. Bivariate and multivariable statistical analysis was then performed. RESULTS: We identified 6,494 patients (mean age, 65 years). Compared with patients with mFI of 0, patients with mFI of 2 or greater were nearly 2.5 times as likely to incur a postoperative complication (1.7% vs 7.4%). Specifically, the rates of Clavien-Dindo IV, wound, cardiac, and renal complications were increased significantly in patients with mFI of 2 or greater. In addition, as mFI increased from 0 to 2 or greater, 30-day reoperation rate increased from 0.8% to 2.4%, 30-day readmission from 0.8% to 4.6%, and LOS from 0.5 days to 1.44 days. Frailty was associated with increased complications as well as rates of readmission and reoperation even when controlling for demographic data, LOS, and operative time. Age alone was not significantly associated with postoperative complications, readmission, reoperation, or LOS. CONCLUSIONS: A state of frailty is highly predictive of postoperative complications, readmission, reoperation, and increased LOS following open reduction and internal fixation of distal radius fractures. Our data suggest that a simple frailty evaluation can help inform surgical decision making in patients older than 50 years with distal radius fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/29980394/Use_of_a_5_Item_Modified_Frailty_Index_for_Risk_Stratification_in_Patients_Undergoing_Surgical_Management_of_Distal_Radius_Fractures_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(18)30711-1 DB - PRIME DP - Unbound Medicine ER -