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Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty.
J Shoulder Elbow Surg. 2019 Jul; 28(7):1232-1240.JS

Abstract

BACKGROUND

Frailty, as quantified by the modified frailty index (mFI), has emerged as a promising method to identify patients at high risk of complications after surgery. Several studies have shown that frailty, as opposed to age, is more predictive of adverse surgical outcomes. We hypothesized that a 5-item mFI could be used to identify patients at elevated risk of complications after total shoulder arthroplasty (TSA).

METHODS

We identified patients aged 50 years or older who underwent TSA in the American College of Surgeons National Surgical Quality Improvement Program database. Pearson χ2 analysis and linear regression were used to determine the association of the mFI score with 30-day postoperative complications, reoperation, readmission, length of stay (LOS), adverse hospital discharge, and mortality rate.

RESULTS

The study included 9861 patients with a mean age of 70 years. As the mFI score increased from 0 to 2 or greater, the following rates increased: postoperative complications from 4.2% to 9.4%, readmission from 1.6% to 4.4%, adverse hospital discharge from 6.3% to 19.6%, and LOS from 1.88 days to 2.43 days (P < .001). Multivariate analysis showed that patients with an mFI score of 2 or greater were over twice as likely to sustain a postoperative complication (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.86-3.10), readmission (OR, 2.80; 95% CI, 1.88-4.17), reoperation (OR, 1.82; 95% CI, 1.02-3.25), and adverse hospital discharge (OR, 3.14; 95% CI, 2.51-3.92). These effects were all significantly higher compared with age.

CONCLUSION

Frailty is associated with increased rates of 30-day postoperative complications, readmission, reoperation, adverse hospital discharge, and hospital LOS after TSA. Use of a simple frailty evaluation may help inform decision making and risk assessment when considering TSA.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: rholzgr@emory.edu.Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.Medical College of Georgia School of Medicine, Augusta, GA, USA.Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30878278

Citation

Holzgrefe, Russell E., et al. "Modified Frailty Index Is an Effective Risk-stratification Tool for Patients Undergoing Total Shoulder Arthroplasty." Journal of Shoulder and Elbow Surgery, vol. 28, no. 7, 2019, pp. 1232-1240.
Holzgrefe RE, Wilson JM, Staley CA, et al. Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty. J Shoulder Elbow Surg. 2019;28(7):1232-1240.
Holzgrefe, R. E., Wilson, J. M., Staley, C. A., Anderson, T. L., Wagner, E. R., & Gottschalk, M. B. (2019). Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery, 28(7), 1232-1240. https://doi.org/10.1016/j.jse.2018.12.004
Holzgrefe RE, et al. Modified Frailty Index Is an Effective Risk-stratification Tool for Patients Undergoing Total Shoulder Arthroplasty. J Shoulder Elbow Surg. 2019;28(7):1232-1240. PubMed PMID: 30878278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty. AU - Holzgrefe,Russell E, AU - Wilson,Jacob M, AU - Staley,Christopher A, AU - Anderson,Travis L, AU - Wagner,Eric R, AU - Gottschalk,Michael B, Y1 - 2019/03/14/ PY - 2018/09/26/received PY - 2018/12/03/revised PY - 2018/12/11/accepted PY - 2019/3/18/pubmed PY - 2019/11/5/medline PY - 2019/3/18/entrez KW - NSQIP KW - Total shoulder arthroplasty KW - complications KW - frailty KW - modified frailty index KW - readmission KW - reoperation KW - total shoulder replacement SP - 1232 EP - 1240 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 28 IS - 7 N2 - BACKGROUND: Frailty, as quantified by the modified frailty index (mFI), has emerged as a promising method to identify patients at high risk of complications after surgery. Several studies have shown that frailty, as opposed to age, is more predictive of adverse surgical outcomes. We hypothesized that a 5-item mFI could be used to identify patients at elevated risk of complications after total shoulder arthroplasty (TSA). METHODS: We identified patients aged 50 years or older who underwent TSA in the American College of Surgeons National Surgical Quality Improvement Program database. Pearson χ2 analysis and linear regression were used to determine the association of the mFI score with 30-day postoperative complications, reoperation, readmission, length of stay (LOS), adverse hospital discharge, and mortality rate. RESULTS: The study included 9861 patients with a mean age of 70 years. As the mFI score increased from 0 to 2 or greater, the following rates increased: postoperative complications from 4.2% to 9.4%, readmission from 1.6% to 4.4%, adverse hospital discharge from 6.3% to 19.6%, and LOS from 1.88 days to 2.43 days (P < .001). Multivariate analysis showed that patients with an mFI score of 2 or greater were over twice as likely to sustain a postoperative complication (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.86-3.10), readmission (OR, 2.80; 95% CI, 1.88-4.17), reoperation (OR, 1.82; 95% CI, 1.02-3.25), and adverse hospital discharge (OR, 3.14; 95% CI, 2.51-3.92). These effects were all significantly higher compared with age. CONCLUSION: Frailty is associated with increased rates of 30-day postoperative complications, readmission, reoperation, adverse hospital discharge, and hospital LOS after TSA. Use of a simple frailty evaluation may help inform decision making and risk assessment when considering TSA. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/30878278/Modified_frailty_index_is_an_effective_risk_stratification_tool_for_patients_undergoing_total_shoulder_arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(18)30945-5 DB - PRIME DP - Unbound Medicine ER -