A Novel Ward-based Comprehensive Geriatric Assessment for Elderly Orthopedic Patients and Analysis of Risk Factors for Postoperative Complications

Background: The effectiveness of comprehensive geriatric assessment (CGA) has been confirmed to reduce perioperative complications of geriatric patients. But there is no universally accepted standardization of CGA for orthopedic surgery. In this study, a novel CGA strategy was applied to evaluate the conditions of elderly patients undergoing orthopedic surgery from a broad view and to identify potential risk factors for postoperative complications. Methods: A prospective cohort study was conducted from March 2019 to December 2020.The study enrolled patients for elective or confined orthopedic surgery if they were over the age of 75 years old. All patients were enrolled and treated with help from a multidisciplinary team. A structured CGA was conducted to identify high-risk elderly patients and to facilitate coordinated multidisciplinary team care by a geriatric team. The basic patient characteristics and CGA results were collected in addition to postoperative complication and mortality rates. Multivariate logistic regression analysis was used to identify risk factors for postoperative complications. Results: A total of 214 patients with an age of 81.07 ± 4.78 (range, 75–100) years were prospectively enrolled in this study. In total, 66 (30.8%) complications were registered, including one death from myocardial infarction (mortality rate, 0.5%). Poor ADL and IADL were accompanied by frailty, worse American Society of Anesthesiologists (ASA) score, visual analogue scale score, and nutritional status. Poor ADL was also associated with higher risks of falling, polypharmacy, and cardiac and respiration complications. Poor IADL was associated with higher risk of cardiac and respiration complications. Higher stroke risk was accompanied by higher risks of cardiac complications, delirium, and hemorrhage. Worse ASA scale was associated with worse ADL, IADL, and frailty, and higher delirium risk. Multivariate logistic regression analysis showed that spinal fusion (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.65 to 0.83; p = 0.0214), blood loss(OR, 1.68; 95% CI, 1.31 to 2.01; p = 0.0168), ADL (severe dysfunction or worse) (OR, 1.45; 95% CI, 1.16 to 1.81; p = 0.0413), IADL (serious dependence) (OR, 1.08; 95% CI, 1.33 to 1.63; p = 0.0436), renal function (CKD ≥ stage 3a) (OR, 2.01; 95% CI, 1.54 to 2.55; p = 0.0133), and malnutrition(OR, 2.11; 95% CI, 1.74 to 2.56; p = 0.0101) were independent risk factors for postoperative complications. All P <0.05. Conclusion: Spinal fusion, blood loss, ADL (severe dysfunction or worse), IADL (serious dependence), renal function (CKD ≥ stage 3a) and nutrition MNA (malnourished) were independent risk factors of postoperative complications following orthopaedic surgery in elderly patients.