Key result
Higher modified Frailty Index was strongly associated with increased 30-day readmission (OR 10.75) and ED visits (OR 4.95) following total joint arthroplasty.
Why the study?
Total joint arthroplasty burdens the healthcare system, prompting efforts to reduce costs through quality measures, but the impact of the Charlson Comorbidity Index and modified Frailty Index on postoperative quality outcomes at a VA hospital required investigation.
Do the Charlson Comorbidity Index and modified Frailty Index predict postoperative outcomes in patients undergoing total joint arthroplasty?
Cohort (n=451)
No
Do the Charlson Comorbidity Index and modified Frailty Index predict postoperative outcomes in patients undergoing total joint arthroplasty?
Odds Ratio: 10.75
p-value: p=≤0.05
Higher Charlson Comorbidity Index and modified Frailty Index scores are associated with increased healthcare utilization, including longer length of stay and higher readmission rates, following total joint arthroplasty.
May flag high-mFI TJA patients for targeted monitoring; leaves open whether frailty-directed interventions reduce readmissions.
Background: Total joint arthroplasty continues to burden the United States healthcare system as the population ages. Efforts to reduce costs have focused on quality measures following joint arthroplasty procedures. The purpose of this study was to investigate the effect of the Charlson Comorbidity Index (CCI) and modified Frailty Index (mFI) on length of stay (LOS), 90-day return to the operating room, 30-day readmission rates, and emergency department (ED) visits within 30 days of a joint arthroplasty procedure at a Veterans Affairs (VA) Hospital. Methods: A retrospective chart review was conducted of patients undergoing total hip or knee arthroplasty between January 2, 2013 and March 1, 2018 (n=451). Postoperative outcomes were evaluated and compared to preoperative calculated CCI and mFI values. Binomial logistic regression was used to determine the effects of CCI and mFI on each of these outcome measures. Odds ratios (OR) were calculated for significant effects (ie, where P ≤0.05). Results: Higher CCI was associated with LOS greater than one day (odds ration [OR]=1.25) and greater probability of readmission within 30 days (OR=1.4). Higher mFI was related to higher probability of postoperative ED visit (OR=4.95) and readmission rate (OR=10.75). Conclusions: Presurgical evaluation utilizing CCI and MFI may better identify those at risk and encourage modified preoperative counseling for these patients. Further study is needed to determine a risk stratification scheme that allows for more accurate prediction of patients who may require more intense hospital-based postoperative care. Level of Evidence: Level IV.
No takes yet. Share an insight, caveat, or question.
Rogozinski et al. (2020) conducted a cohort in Total hip or knee arthroplasty (n=451). Charlson Comorbidity Index (CCI) and modified Frailty Index (mFI) vs. Lower CCI and mFI scores was evaluated on 30-day readmission rate (OR 10.75, p=≤0.05). Higher modified Frailty Index was strongly associated with increased 30-day readmission (OR 10.75) and ED visits (OR 4.95) following total joint arthroplasty.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: